Associate Systems Analyst - Health Plan

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Supports the design, implementation, and maintenance of software systems to meet organizational needs. Assists in system troubleshooting, providing end-user training, and performing basic project coordination. This role works closely with senior team members to ensure system functionality, deliver user support, and enhance operational efficiency. Through effective collaboration and continuous learning, this position contributes to the successful integration and optimization of technology solutions, while providing foundational technical and administrative support for various projects and tasks.

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Bachelor’s degree in Computer Science, Information Technology or a related field OR two (2) years of relevant experience.

2. 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.

PREFERRED QUALIFICATIONS:

EXPERIENCE:

1. Experience in applicable business, clinical, imaging, or web application systems, including advanced workflows, focused on driving efficiency and optimization. 

2. Proficiency in systems administration and providing strategic insights and improvements to business operations. 

3. Experience working in inpatient and outpatient clinical settings, with a focus on improving patient care processes through advanced system implementations. 

4. Understanding of clinical data management and healthcare interoperability standards (HL7, FHIR, DICOM) to ensure seamless data exchange and compliance. 

5. Knowledge in Cloud-based healthcare applications and web services, ensuring secure, scalable, and efficient system architecture supported by this role. 

6. Knowledge of reporting tools, delivering actionable insights and enhancing decision-making processes through comprehensive data analysis and reporting capabilities

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position.  They are not intended to be constructed as an all-inclusive list of all responsibilities and duties.  Other duties may be assigned.

1. System Maintenance, Updates, and Innovation:

• 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.

2. Collaboration and Communication:

• 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.

3. Project Coordination:

• 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.

4. Training and Education:

• 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.

5. Continuous Learning and Knowledge Development:

• 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.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Frequent walking, standing, stooping, kneeling, reaching, pushing, pulling, lifting, grasping are necessary body movements utilized in performing duties through the work shift.

2. Ability to sit for extended periods of time.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Standard office environment.

2. This position may require travel to other West Virginia United Health System (WVUHS) facilities or affiliated sites to assist with implementations, training, and/or support.

SKILLS AND ABILITIES:

1. Analysis and Assessment:  Foundational experience in analyzing business needs, documenting functional specifications, and supporting alignment with technical solutions. Capable of utilizing data insights to assist in decisions related to software procurement, installation, and configuration. Demonstrates growing proficiency in utilizing tools such as process maps, workflow diagrams, and data analytics to support system design, training, and problem resolution.

2. Attention to Detail: Demonstrates foundational skills to troubleshoot and test systems, assisting in identifying and resolving potential issues to support functionality and reliability.

3. Communication, Relationship Building, and Teamwork: Demonstrates written and verbal communication skills to convey technical information clearly. Applies interpersonal skills to build relationships and support collaboration within teams. Actively contributes to a positive team dynamic by participating in group problem-solving, sharing knowledge, and fostering a collaborative environment.

4. Adaptability and Change Management:  Demonstrates ability to respond to unexpected changes and system issues, applying foundational coping skills to assist in minimizing disruptions and maintaining operations.

5. Time Management:  Shows ability to prioritize and manage multiple tasks and deadlines, working to ensure timely and accurate completion while contributing to team goals.

Additional Job Description:

Position Summary

This position provides specialized clinical and health plan expertise within the Systems Analyst function, supporting Utilization Management (UM), Pharmacy, and related payer workflows. The role serves as a liaison between IT and clinical/operational teams to translate medical, pharmacy, and regulatory requirements into effective system solutions.

Core Responsibilities

• 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.

Preferred Qualifications

• 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.

Scheduled Weekly Hours:

40

Shift:

Day (United States of America)

Exempt/Non-Exempt:

United States of America (Exempt)

Company:

SYSTEM West Virginia University Health System

Cost Center:

5816 SYSTEM IT Health Plan

Address:

315 Point Marion Road

Morgantown

West Virginia

Equal Opportunity Employer

 

West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.