Systems Analyst - QNXTPrimary Location: Phoenix, AZ
Additional Locations: AZ-Phoenix Apply
Knowledge of claim system, QNXT, and able to support modifications to the build to support Medicaid and Medicare Advantage business in Arizona.
- Provides input on business plan to achieve business goals.
- Proactively leads assigned project by creating project timeline, identifying key milestones and additional resources needed to successfully complete the work.
- Assists with the management of internal relationships, processes and performance drives (in some cases relationships may be external).
- Negotiates to obtain additional resources (may be cross functional/segment).
- Responsible for the financial implications of the project.
- Identifies issues that may stall project and works with manager to address them.
- Tracks progress and communicates project status on a regular basis to all impacted parties.
- Communicates changes and updates to ensure all impacted parties (up stream/down stream) are informed of next steps for completion.
- Acts as an advocate for change, may require influencing others to see the value in project.
- Group facilitation/presentation influencing various internal (these may be cross-functional/segment) may also include external parties.
- May coach or mentor others by providing work direction.
- May identify gaps and recommend enhancements related to new and/or existing products, services and workflows based on broad view of the organization.
- Develops recommendations based on complex data and root cause analysis.
- May serve as a Subject Matter Expert for contract, benefit configuration in QNXT.
Proven track record meeting project dates.
3-5 years related work experience.
Claim - Policies & procedures
Communication - Provider communications
General Management - Data analysis & interpretation
General Management - Process & quality improvement
General Management - Data tools: building & utilization
Information Management - Business information analysis
Information Management - Researches overpayments and prepares projects for recovery
Information Management - Supports the maintenance of scoreable action items documents by providing ad hoc analysis
Project Management - Issue identification and analysis
Aetna Application - Alchemy Search
Aetna Application - Claim Reporting System
Aetna Application - Credentialing and Recredentialing Data Sys
Aetna Application - EDI Claim Lookup
Aetna Application - MBU Encounter Management System
Aetna Application - PCR Form
Aetna Application - Plan Reference Table
Aetna Application - Provider Contracts
Aetna Application - Provider Directory Reporting
Aetna Application - QNXT
Aetna Application - Repricer
Database - Microsoft SQL Server
- Ability to communicate effectively with management.
- Ability to work collaboratively within work teams.
- Excellent verbal and written communication skills.
- Strong organization skills.
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