QNXT Business Analyst-Claims- Remote

Sentara Health Plans is currently hiring anBusiness Analyst-Operations- Glen Allenfor Virginia Premier!This is a Full Time position with day shift hours and great benefits!Candidates may work remotely in VA, NC, WA, NV, FL, IN, SD, GA, SC, TN, TX, WV and WI! Job responsibilities:The Business Analyst position is responsible for the Quality Assurance (QA) review of system configuration changes made to VPHP's claims processing, editing and pricing systems. The Business Analyst plays a key role in identifying, reviewing, and documenting all results related to the QA review of these system changes. In addition, the analyst will perform pre /post payment random and focus audits. The analyst will develop a working knowledge of the system configuration of business rules that support coverage of services, as well as the system configuration of contracts and fee schedules that support reimbursement.Job Requirements: Experience in lieu of education: YesRequired: Information Technology - 1 yearStrongly preferred: Intermediate to advanced experience in writing SQL queries; QNXT experiencePreferred: Experience configuring Health Claims Systems for Benefits, Contracts for Government Programs (Medicaid and Medicare) and Commercial PlansKnowledge of Health Claims processingStrong analytical & problem-solving skillsAbility to analyze complex issues and large amounts of dataStrong written and verbal communicationDetail orientedPrior quality experienceGood time managementSentara Health Plans is the health insurance division of Sentara Healthcare doing business as Optima Health and Virginia Premier. Sentara Health Plans provides health insurance coverage through a full suite of commercial products including consumer-driven, employee-owned and employer-sponsored plans, individual and family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees.With more than 30 years' experience in the insurance business and 20 years' experience serving Medicaid populations, we offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services - all to help our members improve their health.Designs, produces and analyzes customer operations data. Creates and maintains reports for business operations and special projects as it pertains to operational processes. Utilizes knowledge of numerous applications, databases, information systems, statistical tools and analytical principles to monitor and analyze information in support of the business. Assists in the implementation, maintenance and improvement of information systems.Education LevelBachelor's Level Degree - Experience in lieu of education: YesExperienceRequired: Related - 1 yearPreferred: None, unless noted in the "Other" section belowLicenseNone, unless noted in the "Other" section belowSkillsRequired: Preferred: None, unless noted in the "Other" section belowOtherRelated experience will be in one of the following areas, operations, IT, or reporting.