Business Analyst - NCPDP Technology

- Analyze, plan, design, document, and propose enhancements to business processes to align with client technological goals - Act as a liaison among clients, project managers, and technical teams to define, monitor, and communicate business requirements and their potential impacts by developing fundamental conceptual data and process models - Create, execute, or assess basic testing scenarios to confirm that client specifications are integrated into system designs - Ensure the intended purpose of changes is maintained throughout all project phases by engaging in technical evaluations and reviews - Conduct regular audits of business procedures, policy documents, and operational workflows to guarantee compliance with internal standards and regulatory mandates - Review and verify policy application across various departments, identifying discrepancies, risks, and areas for improvement - Formulate audit plans, checklists, and methodologies to uphold consistent and repeatable auditing practices - Document audit results and prepare clear, actionable reports for leadership and stakeholders - Analyze, estimate, design, document, and implement configurable policy-based system modifications in Claims, Reference Data Maintenance, and Business Policy Administration (BPA) areas - Possess practical experience with all four claim forms: Physician, Institutional, Dental, and Pharmacy - Update member benefit plan configurations as necessary - Develop solutions and design new system functionalities to audit or deny claims according to client specifications - Execute quarterly code set updates, incorporating coverage/reimbursement rules, and revising state-specific service restrictions for all procedure, revenue, NDC/GSN/STC code types