Salesforce Solution Analyst (HEDIS, HIPAA, ACA, Healthcare)

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview 

The Information Technology Department is excited to announce a position for a Salesforce Solution Analyst focused on our Health Insurance Application Development Team. We are seeking a proactive and detail-oriented individual who can bridge the gap between business needs and technical solutions. As the health insurance landscape evolves, this role is pivotal in ensuring that our application developments remain aligned with business requirements and industry best practices.

• Collaborate closely with stakeholders within the health insurance domain to gather, document, and validate business requirements.
• Translate business needs into detailed technical specifications, ensuring that application developments align with organizational goals and industry standards.
• Act as a liaison between the development team and the business units, facilitating smooth communication and ensuring mutual understanding.
• Review and analyze current application workflows, pinpointing areas of improvement and recommending system enhancements.
• Develop and maintain detailed project documentation, including use cases, flowcharts, user stories, and functional specifications.
• Participate in the testing phase of application development to ensure deliverables meet specified requirements.
• Stay updated with the latest trends in health insurance and application development, ensuring the relevancy and competitiveness of our solutions.
• Conduct impact analysis for any proposed changes or enhancements to the system.
• Provide training and support to end-users upon application rollout.
• Design and implement data analysis methodologies to support decision-making and strategic planning within the payer healthcare industry.
• Work with Salesforce CRM to manage customer relationships, track engagements, and improve service delivery.
• Optimize business processes through the integration of Salesforce solutions, ensuring alignment with healthcare compliance and regulations.
• Facilitate user acceptance testing (UAT) with stakeholders to validate the functionality and usability of Salesforce implementations.
• Develop and deliver reports and dashboards within Salesforce to provide actionable insights to business leaders.
• Coordinate with development and cybersecurity teams to ensure the protection of sensitive health data within systems and applications.

• Bachelor’s degree in business, Information Technology, or a related field.
• At least 5 years of experience as a Business Analyst and 3 years within the health insurance or healthcare sector.
• Familiarity with application development processes, methodologies, and tools.
• Exceptional communication skills, both written and verbal, with the capability to articulate complex concepts to diverse audiences.
• Strong analytical, problem-solving, and organizational skills.
• Experience with Salesforce CRM and the ability to leverage its capabilities to meet business needs.
• Understanding of payer healthcare systems, including claims processing, member services, and provider management.
• Knowledge of regulatory compliance standards relevant to the healthcare industry, such as HIPAA, ACA, and HEDIS.
• Expertise in Salesforce CRM to streamline customer interactions and internal processes.
• Business Analyst certification, such as CBAP or PMI-PBA, is a plus

Professional Competencies 

• Deep understanding of the health insurance industry, its challenges, and operational dynamics.
• Ability to balance technical prowess with business acumen.
• Proficiency in using business analysis tools and software.
• Collaborative mindset, adept at building strong relationships across functional teams.
• Capacity to manage multiple projects simultaneously, prioritizing based on business impact.
• High degree of adaptability in a fast-paced, ever-evolving environment.
• Strong data management skills, with the ability to interpret and visualize data for stakeholder communication.
• Proactive approach to identifying and resolving issues before they impact the business.
• Commitment to continuous learning and professional development, particularly in emerging healthcare technologies and Salesforce updates.

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