Senior Business Analyst

Omegahires; United States; Sur place; USD 120 000 - 150 000; Plein temps

Résumé du poste

Himalayas is seeking a Senior Business Analyst to lead the health care Claims domain, drive the claims module, coordinate with customers, and ensure quality throughout the lifecycle.

You will analyze business requirements, develop documentation, run queries, demos, and collaborate with development, architecture, and design teams to define GUI and platform needs.

Qualifications

• Strong health care domain experience with Medicaid and Medicare.
• Hands-on experience in claims processing and adjudication.
• Experience with sets required in claims adjudication.
• Understanding in configuring benefits or programs in claims systems.
• Ability to run queries and perform basic system analysis and root cause analysis.
• Excellent written and spoken communication skills.
• Ability to multitask between internal teams and clients.
• In-depth understanding of claims lifecycle: member, provider, submission, adjudication, payment, reporting.
• Familiarity with claim types (professional, dental, institutional, pharmacy) and EDI formats.

Responsabilités

• Play the role of Claims Domain lead for health care projects.
• Drive the claims module and process, ensuring quality and coordination with customers.
• Analyze business requirements, design and develop documentation.
• Meet customer expectations, troubleshoot problems in the application, and assist decisions.
• Work in a team environment and provide guidance throughout the life cycle.
• Conduct demos at milestone completion and track feedback from demos.
• Collaborate with development, architecture, and design teams to define GUI view and platform requirements.

Connaissances

Healthcare domain expertise

Medicaid/Medicare knowledge

Claims processing & adjudication

SQL

EDI X12 formats

Analytical thinking

Communication skills

Multitasking across teams

Claims lifecycle knowledge

CMdS/GHS/Facets familiarity

Outils

Postman

EDI tools

CMdS

GHS

Facets

Description du poste

Senior Business Analyst Responsibilities:-

• - Play the role of Claims Domain lead for health care projects.
• - Drive the claims module and process, ensuring quality and coordination with customers.
• - Perform analysis of business requirements, design and develop documentation.
• - Meet customer expectations, troubleshoot problems in the application, and assist customers in implementation decisions.
• - Work in a team environment and provide guidance throughout the entire life cycle.
• - Conduct demos at completion of milestones and track feedback from such demos.
• - Collaborate closely with development, architecture, and design teams to define GUI view and platform requirements.

Required Skills:-

• - Strong health care domain experience with good knowledge of Medicaid and Medicare.
• - Hands-on experience in claims processing and adjudication processes.
• - Experience with sets required in claims adjudication.
• - Prior experience or understanding in configuring benefits or programs in claims systems across various sub-systems.
• - Ability to run queries and perform basic system analysis and root cause analysis.
• - Excellent written and spoken communication skills.
• - Ability to multitask between internal teams and clients based on priority tasks.
• - In-depth understanding of claims and claims lifecycle, including member, provider, claim submission, adjudication, payment cycle, and reporting.
• - Familiarity with claim types (professional, dental, institutional, pharmacy) and claim formats (EDI X12 formats like 837P/I/D, 835, 834, 270/271, 276/277).
• - Familiarity with claim systems like CMdS, GHS, Facets, etc.

Technical Skills:-

• - Proficiency in SQL for validating data in backend tables.
• - Experience with EDI tools for validating X12 files.
• - Understanding of interface testing and data flow between systems using tools like Postman.

Preferred Skills:-

• - Minimum of 8+ years of experience in health care, especially in the MMIS domain.
• - Capability to think creatively to develop new solutions as needed.
• - Ability to validate test scenarios, test plans, and test data.
• - Experience in reviewing requirements, documentation, and creating Requirements Traceability Matrix (RTM).
• - Excellent communication skills to engage with various stakeholders, including QA/dev teams, clients, end users, and business units.
• - Ability to assess current product functionality against market trends and regulatory requirements for future versions.
• - Ability to drive and share requirements with technical teams regarding product features to be implemented.

Originally posted on Himalayas