Business Analyst- PA Prior Authorizations expertise

Lancesoft; Quincy (MA); Hybrid; USD 70,000 - 95,000; Full time

Job summary

Lancesoft is seeking a Business Analyst with PA Prior Authorizations expertise to join our MMIS team on MassHealth projects in Quincy, MA. This role focuses on provider reimbursement and claims processing, supporting development, testing and implementation to meet business objectives.

The BA will work across SDLC with stakeholders, vendors and project teams in a hybrid setup. A Bachelor's degree in Business/IT/Healthcare and 3+ years of relevant experience are preferred, with strong

Qualifications

• Experience with Medicaid MMIS or MassHealth preferred.
• Strong SQL data analysis skills for claims data.
• Knowledge of HIPAA claims and payment processing.

Responsibilities

• Lead and participate in joint application design sessions with stakeholders.
• Knowledge of SDLC and Agile methodologies is a plus.
• Develop test strategies, test scenarios and test cases based on written requirements.
• Execute and review test runs and sign off on testing components.
• Document requirements and participate in their development and testing.
• Coordinate with vendors to ensure business requirements are defined and tested.
• Provide back-up to other business analysts as needed.
• Data query and analysis.

Skills

SDLC

Agile

SQL

HIPAA

Data analysis

Education

Bachelor's degree or higher in Business, IT or Healthcare administration

Job description

Title: Business Analyst- PA Prior Authorizations expertise Duration: 12 months Work Hours: 37.5 Hrs/week Location: 1 ENTERPRISE DRIVE, Quincy, Massachusetts 02171 Position: Hybrid

The client is seeking to hire a Business Analyst- PA Prior Authorizations expertise to join our collaborative Medicaid Management Information System (MMIS) team. The Business Analyst (BA) will work on our established Provider Reimbursement and Claims processing functional areas to support the development, testing and implementation of projects and enhancements to meet the business objectives of the MassHealth (Massachusetts Medicaid) program specifically projects to support the member community.

BA should be well versed in health plan management, operational concepts, and the systems development lifecycle. Preference will be given to candidates with Medicaid systems experience well as claims and business knowledge of the MassHealth program.The BA must have sufficient knowledge of the entire scope of the health care business systems and excellent knowledge in the Claims Processing area including PA. PAS, and Referrals. To ensure that the development and testing work within their functional area is compatible with the MMIS system.

The BA's primary responsibility is to ensure that the implemented coding scheme meets the requirements of the business community and conforms to all applicable Federal and state laws. The BA will be called upon to act as an active member in all phases of the project including gap analysis, requirements gathering, design and development activities, documentation, testing, implementation, and stabilization.

The BA will be expected to work independently, as part of a team as well as with business stakeholders so excellent communication and documentation skills is a requirement for this job. Knowledge of Interoperability and X.12 emerging standards is beneficial.

The primary work location for this role will be at 1 ENTERPRISE DRIVE, Quincy, Massachusetts 02171. The work schedule for this position is Monday thru Friday, 9: 00AM to 5: 00PM. This position is expected to follow a hybrid model of reporting to work that combines in-office workdays and work from home days as needed. Schedules are subject to change based on the operational needs of the business.

DETAILED LIST OF JOB DUTIES AND RESPONSIBLITIES

• Lead and participate in joint application design session with stakeholders
• Knowledge of SDLC and Agile methodology a plus
• Develop test strategies, test scenarios and test cases based on written requirements
• Execute and review test runs and sign off on testing components
• Document requirements and participate in their development and testing
• Support the development of end-user training materials and end-user documentation as required.
• Possible oversight role during the stabilization phase of each release including the monitoring of system change execution, the development of system "fix"strategies and the close monitoring of the implementation of those strategies
• Work with vendors to ensure business requirements are fully defined and tested.
• Communicate updates and changes to impacted stakeholders
• Represent MMIS in business meetings as needed
• Support program staff, vendors, and other stakeholder with MMIS related questions or concerns.
• Provide back up to other business analysts as needed.
• Data query and analysis.

Preferred Qualifications:

• Proficient in business analysis to support all stages of system project lifecycle
• Competency in HIPAA claims and payment transaction processing
• Strong data analysis skills- SQL proficient
• Excellent communication and documentation skill
• Excellent interpersonal skills necessary to interact effectively with project managers, developers, business analysts, systems analysts, SQA analysts, business users/stakeholders, and data processing personnel;as well as interact with representatives from external agencies and companies.
• Demonstrated ability to work independently, as well as within project teams, providing relevant system analysis services.
• Highly analytical, with the ability to independently analyze, document findings and recommend solutions.

Education and Certifications:

Bachelor's degree or higher in Business, IT or Healthcare administration with minimum 3 years' experience, or equivalent in healthcare administration setting