Business Analyst - Prospective Payment System (PPS)

Minneapolis, Minnesota
Sep 16, 2017
Oct 21, 2017
Employment Status
Full Time

Health Care that Starts with You!

Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota's leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs. UCare is growing in size, membership, products, geographic coverage, and employees. We're an organization that's going places. Be part of a team that cares about you, be part of UCare.



At UCare, we deliver high-quality health coverage and services to help members of all ages maintain and improve their health. It's a big job that takes innovative ideas, strategic partnerships, and a commitment to doing the right thing. Above all, it takes a compassionate team that is dedicated to making a real difference in the lives of our members and our communities.


Working at UCare is more than just a career; it's a mission. A mission that defines us as professionals, unites us as an organization, and shapes how we interact with our members and each other. Our values of integrity, community, quality, flexibility, and respect permeate every aspect of our organization - from who we are and how we act, to what we do and how we do it. We owe our continued success to our employees who proudly embody our mission and values in everything they do.


Position Description

This position is responsible to service as a liaison between UCare and Claims Editing System (CES) and Prospective Payment System (PPS) vendor.  Accurately elicit, analyze, communicate and validate requirements for upgrades and updates to CES and PPS.   Understand business problems and opportunities in the context of the requirements that enable the organization to achieve its goals.  Work with UCare's and vendor's IT experts to address upgrade and updates to CES, PPS and any related hardware and/or software updates.  Stay current on vendor product and enhancement requirements. Troubleshoot both technical and business issues, determining root cause, solutions and communicating with all affected areas within UCare.  Consult with UCare users to identify current operating procedures and to clarify program objectives and responsible for writing documentation to describe custom configuration of applications and operating procedures.  Coordinate testing scenarios and assist in testing where applicable.  Collaborate with Project Managers to implement larger scale updates to the software/applications.

·Serve as a liaison between UCare business stakeholders, CES & PPS vendor and IT to ensure accurate and timely communication of upgrades and updates to CES and PPS.

·Partner with vendor to ensure UCare successfully implements edit rules, custom rules and pricing modules.

·Collaborate cross-functionally with appropriate UCare departments and vendor to develop CES and PPS updates, training materials, business requirements including interfaces and supporting applications.

·Perform problem solving and root cause analysis to resolve systems and/or business issues.

·Provide explanation and information to UCare departments/teams as applicable as well as external resources translating technical details.

·Review Release Notes from vendor in regards to upgrades and/or updates for: WebStrat, EasyGroup, New Rate Manager, CLAD Interface and any other upgrades or updates that are applicable to the Prospective Payment System.

·Translate technical release notes into business requirements and language understood by all impacted UCare business areas.

·Participate in activities related to the testing of core systems, database impacts, and interfaces to meet the business requirements.

·Support day to day operations to assure the business operations are running as expected.

·Serve as a point of contact for assisting in the reconciliation of issues around Claims processing as it pertains to the CES and PPS upgrades and/or updates.

·Collaborate with other team members, effectively communicating issues that may arise.

·Serve as a Subject Matter Expert on CES, WebStrat, EasyGroup, Rate Manager, CLAD, etc.

·Other projects and duties as assigned.


Bachelor's degree or equivalent preferred; demonstrated experience in a health care environment performing system analysis, business analysis, configuration or analysis and support of claims adjudication may be considered in lieu of degree.

Required Experience

Three years' experience as business analyst. Three years of technical analysis experience as well as Quality Assurance experience.  Experience in a Managed Health Care organization.  Expertise in the implementation, support and troubleshooting of applications software.  Experience with configuration of business rules in a healthcare claims processing application.

Preferred Experience

Understanding of SQL and Business Objects is a plus. Systems knowledge of Amisys, Claims processing, Claims Editing System and Prospective Payment System.


UCare is proud to be a recognized Star Tribune Top Workplace for the 8th consecutive year. As a part of our collaborative team, you'll experience the rewards that come with helping others and seeing the positive results of your hard work. We value and respect each individual's ideas and contributions, and give you the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, a myriad of volunteer activities, and a number of other rewards. If you're looking for a welcoming environment that celebrates what you have to offer, helps you build on your strengths, and gives you the opportunity to truly make a difference, we invite you to apply.

As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.






Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You'll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis just minutes from major freeways and retail centers. At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.

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