SHSMD Career Center

Overview

The Senior Network Systems Analyst develops, administers, and maintains analysis functions and special projects related to all lines of business in Provider Network Management. The Network Systems Analyst plays a critical role in the process, primarily focusing on user alignment with our contracting, provider data management, network management and reporting tools. This involves translating business requirements and rules into systems; understanding how data is created; administration of claims and provider data and network management systems; improving health care delivery by demonstrating great communication and collaboration skills with business customers and managers, analytics, and technology teams; Interfacing with internal and external customers via phone and/or correspondence to answer inquiries; and investigate, and resolve issues related to networks, claim system configuration and accurate processing.

Join Our Medical Group

Northwest Permanente is a self-governed, physician-led, multi-specialty group of 1,500 physicians, surgeons, and clinicians, caring for 630,000 members in Oregon and Southwest Washington. Kaiser Permanente is one of the nation's preeminent health care systems, a benchmark for comprehensive, integrated, value-based, and high-quality care.

Responsibilities

Major Responsibilities / Essential Functions

Business Requirements & Solution Design

• Develop requirements for complex process or system solutions within assigned business domain(s) by interfacing with stakeholders and appropriate IT teams
• Provide technical support to maintain business systems, ensuring that NWP business information needs are met
• Develop straightforward business systems according to specifications
• Participate in periodic review to identify application improvements needed to support evolving business needs
• Ensure integration with other business applications, and consistency with established data/information standards
• Map and document current state against future state processes and maintain clinical integration workflows
• Identify the impact of requirements on upstream and downstream solution components
• Provide recommendations to management and business stakeholders on how to integrate requirements with current systems and business processes across markets or domains
• Quickly learn new technologies, think out-of-the-box to find creative solutions, and connect with both technical and non-technical audiences

Project Delivery & Process Optimization

• Defines project scope and objectives based on business unit needs combined with a thorough understanding of business systems and industry requirements
• Participate on project teams to develop/enhance business information systems
• Lead assigned workstreams and drive completion of deliverables
• Track progress and notify management of issues that require escalation and assume responsibility for resolving or coordinating the resolution of system and process issues
• Interface in various forums to report on project and program milestones and present project needs and technical knowledge
• Identify and validate value gaps and opportunities for process enhancements and/or efficiencies
• Support continuous process improvement by participating in the development, implementation, and maintenance of standardized tools, templates, and processes across multiple business domains

Claims Configuration & Quality Validation

• Partner with Provider Contracting in the development of provider reimbursement methodologies that align with system capabilities, as well as internal and external regulatory policies, in order to minimize potential claim adjudication errors and rework
• Analyze and validate new and amended contract fee schedules and internal policy to determine impact of proposed methodologies to business systems
• Assist in the development of best practice guidelines for provider payment methodologies for both business systems and contracts
• Perform detailed root cause analysis on configuration production issues based on knowledge of system functionality and contractually expected outcomes
• Work with various departments, such as UM, Claims, and Contracting, to ensure that cross-functional processes are in line with system functionality, provider contracts, and regulatory requirements
• Perform quality assurance application testing to include: validation of design to business requirements; writing test plans; and conducting functional and performance testing to include application and system integration testing

Resolution & Reporting

• Perform detailed research and impact analysis: compile and organize information; prepare reports; present findings and recommendations to large and small audiences
• Track and trend provider and/or claim issues
• Work in conjunction with Network Operations and Provider Relations to resolve individual provider issues, including contacting other departments for assistance if necessary, and performing outreach for resolution
• Apply business area and system knowledge to research and remediate system problems
• Identify areas of concern that may compromise provider satisfaction
• Receive and respond to all department inquiries, internal and external, within a timely manner
• Communicate regularly with stakeholders and provide consistent followup on the status of issues
• Responsible for defect management including monitoring and reporting on defect resolution

Qualifications

Minimum Education

• Bachelor's degree in healthcare, business, information technology or related discipline

Minimum Work Experience

• Minimum four (4) years of business systems analysis experience in electronic medical record, claims, reimbursement, contracting, financial or network modeling systems
• Minimum two (2) years of system implementation and process improvement experience

Additional Requirements

• Deep understanding of IT processes, including SDLC and change management framework
• Demonstrable ability to work autonomously, manage and lead projects or parts of larger programs requiring program management involvement
• High level of intellectual curiosity to understand current state, identify issues and provide solutions, while advising on positive and negative implications of decisions
• Strong verbal and written communication capabilities to work with both technical and nontechnical personnel at various levels in the organization
• Effective at complex problem resolution and expected to assist in resolving all difficult issues, expanding the solution to include infrastructure, architecture, and multitier tools and business system strategies
• Skills associated with analysis of processes and issues of moderate scope, information flow and architecture
• Process flow and desk procedure development and documentation
• Development of business specification documentation such as business requirements, technical and nontechnical specifications, test plans and scripts
• Proven ability to conduct, interpret and communicate quantitative/qualitative analysis

Required Licensure, Certification, Registration (LCR)

• Six Sigma or Lean Six Sigma Green Belt Certified within one (1) year in the role

Preferred Education

• Bachelors degree in healthcare, business, information technology or related discipline

Preferred Work Experience and Qualifications

• Minimum six (6) years experience in healthcare with a focus in business analysis
• Minimum four (4) years experience in system implementation or process improvement
• Strong critical thinking skills, experience working with large data sets, ability to draw inferences, and a natural curiosity to identify and interpret trends and patterns in datasets to locate influences
• Experience in presenting and interpreting analysis results, summarizing conclusions, and recommending a course of action
• Ability to see the big picture, and come up with creative solutions when faced with challenges
• Knowledge of contracting claims and network management and relevant business systems and data sources such as Epic
• Proficiency in the use of current software and exposure to Epic, SAS/SQL, Tableau, PowerBI, Oracle and Microsoft Office 365 application suite

Equal Opportunity Employer

At Northwest Permanente, we are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants without regard to race, color, religion, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical and mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military and veteran status, and any other characteristic protected by applicable law. Northwest Permanente believes that equity, inclusion, and diversity among our employees are critical to our success, and we seek to recruit, develop, and retain the most talented people from a diverse candidate pool.