Associate Systems Analyst - Health Plan

Summary

WVU Medicine, part of the West Virginia University Health System, is seeking an Associate Systems Analyst to support healthcare technology solutions. The role assists with system maintenance, configuration, testing, troubleshooting, project coordination, user training, and optimization, with a specialized focus on Utilization Management, Pharmacy, and health plan workflows.

Responsibilities

• Assist in Diagnosing and Resolving IT Issues: Support daily troubleshooting and problem-solving efforts to maintain and optimize system functionality, escalating issues as needed
• Support System Modifications, Implementation, and Testing: Help implement and test system updates for basic workflows, ensuring reliable functionality and supporting optimization initiatives
• Participate in Functional and Integrated Testing: Engage in testing activities to verify and optimize system performance, documenting results and identifying areas for improvement
• Contribute to System Error Correction and Optimization: Aid in identifying, diagnosing, and correcting system errors to maintain smooth operations and timely resolutions
• Assist with User Security Management: Apply user security settings under the guidance of senior analysts to uphold data integrity and optimize access control
• Collaborate on System Enhancements and Optimization: Work with senior team members to suggest and implement updates or new functionalities based on organizational needs, focusing on system efficiency and best practices
• Support Data Import/Export and Basic Reporting: Assist in managing data transfers and generating basic reports, contributing to accurate data handling and reporting optimization
• Collaborate Effectively and Proactively Communicate: Work closely with team members, providing clear updates to ensure alignment with project goals
• Effectively Communicate with Business Partners: Engage with business partners to understand needs, gather requirements, and ensure technical solutions align with business objectives
• Foster a Positive Team Environment: Contribute to a supportive, respectful, and collaborative work culture
• Demonstrate Openness to Feedback and Continuous Improvement: Actively seek and apply feedback and suggest process improvements
• Ensure Reliable Remote Communication: Maintain consistent communication with the team for seamless collaboration
• Project Planning and Scheduling: Help define scope, plan, deliverables, schedules, and milestones
• Coordination: Help oversee a project, acting as a contact for team members, colleagues, and stakeholders to ensure the smooth execution of projects
• Communication: Help ensure proper communication of information within the project team. Including facilitation of regular meetings, documentation of meeting notes and action items
• Documentation and Reporting: Assist with maintaining project documentation, including project scope, plans, reports, and status updates
• Risk Management: Help identify risks, create risk mitigation plans, and ensure contingency measures are in place
• Issue Management: Help identify problems in the project and assists in finding solutions to keep the project on track
• Provide End-User Support and Training: Deliver classroom, one-on-one, and/or remediation training to support end-users' effective use of systems
• Assess User Readiness and Abilities: Evaluate staff readiness and skill levels to ensure proper use of systems and identify any additional training needs
• Deliver Systems Support: Offer ongoing end-user systems support to resolve issues and enhance system proficiency
• Content Development: Contribute to curriculum development to support the creation and delivery of effective training materials that align with organizational workflows and objectives
• Demonstrates growing commitment to expanding technical knowledge
• Utilizes resources such as application community sites, professional networks, and industry tools
• Applies new skills to support tasks and contribute to team objectives
• Attends basic training sessions and workshops
• Follows industry news and monitors basic trends
• Identifies key areas for personal and professional improvement
• Participates in team discussions and knowledge-sharing activities
• Conducts basic research for projects and contributes to content development
• Accepts and incorporates feedback from peers and supervisors
• Shares knowledge informally with peers
• Collaborates with other teams to gain a better understanding of their processes
• Support system configuration, testing, implementation, and optimization for Utilization Management and Pharmacy workflows, including prior authorization, medical necessity review, and clinical determinations
• Serve as an IT liaison to UM, Pharmacy, Medical Management, and other clinical health plan teams
• Translate clinical and operational requirements into system requirements, workflows, and testing scenarios
• Support Epic Tapestry and integrated vendor solutions related to medical and pharmacy management
• Support clinical workflows associated with prior authorization, appeals and grievances, pharmacy management, and utilization review
• Assist with implementation of applicable CMS, NCQA, Medicare Advantage, D-SNP, ACA, and other payer regulatory requirements
• Participate in end-to-end testing and issue resolution across authorization, benefits, claims, pharmacy, and related clinical workflows
• Identify opportunities to improve and automate clinical health plan workflows through technology

Skills

• Bachelor's degree in Computer Science, Information Technology or a related field OR two (2) years of relevant experience
• Relevant certifications and/or proficiencies may be required for this position, with a target completion within 90 days following formal training provided by WVUHS Information Technology
• Experience in applicable business, clinical, imaging, or web application systems, including advanced workflows, focused on driving efficiency and optimization
• Proficiency in systems administration and providing strategic insights and improvements to business operations
• Experience working in inpatient and outpatient clinical settings, with a focus on improving patient care processes through advanced system implementations
• Understanding of clinical data management and healthcare interoperability standards (HL7, FHIR, DICOM) to ensure seamless data exchange and compliance
• Knowledge in Cloud-based healthcare applications and web services, ensuring secure, scalable, and efficient system architecture supported by this role
• Knowledge of reporting tools, delivering actionable insights and enhancing decision-making processes through comprehensive data analysis and reporting capabilities
• Clinical background or licensure strongly preferred, such as RN, LPN, PharmD/RPh, Pharmacy Technician, or comparable clinical experience
• Experience with Utilization Management, Pharmacy, prior authorization, Medical Management, or other managed care operations preferred
• Health plan, payer, PBM, or managed care experience preferred
• Experience with Epic Tapestry or comparable payer technology preferred
• Working knowledge of health plan concepts including benefits, claims, authorizations, medical necessity, and pharmacy benefits
• Ability to translate clinical and operational needs into technical requirements and communicate effectively between clinical, operational, and IT teams

Qualifications

Must Haves

• Bachelor's degree in Computer Science, Information Technology or a related field OR two (2) years of relevant experience
• Relevant certifications and/or proficiencies may be required for this position, with a target completion within 90 days following formal training provided by WVUHS Information Technology

Nice to Haves

• Experience in applicable business, clinical, imaging, or web application systems, including advanced workflows, focused on driving efficiency and optimization
• Proficiency in systems administration and providing strategic insights and improvements to business operations
• Experience working in inpatient and outpatient clinical settings, with a focus on improving patient care processes through advanced system implementations
• Understanding of clinical data management and healthcare interoperability standards (HL7, FHIR, DICOM) to ensure seamless data exchange and compliance
• Knowledge in Cloud-based healthcare applications and web services, ensuring secure, scalable, and efficient system architecture supported by this role
• Knowledge of reporting tools, delivering actionable insights and enhancing decision-making processes through comprehensive data analysis and reporting capabilities
• Clinical background or licensure strongly preferred, such as RN, LPN, PharmD/RPh, Pharmacy Technician, or comparable clinical experience
• Experience with Utilization Management, Pharmacy, prior authorization, Medical Management, or other managed care operations preferred
• Health plan, payer, PBM, or managed care experience preferred
• Experience with Epic Tapestry or comparable payer technology preferred
• Working knowledge of health plan concepts including benefits, claims, authorizations, medical necessity, and pharmacy benefits
• Ability to translate clinical and operational needs into technical requirements and communicate effectively between clinical, operational, and IT teams