Job Description :
Education and Experience »

A Bachelor’s Degree in Business or IT (or equivalent work experience) is required
Strong to extensive Medicaid experience is required
Data management experience is required
Experience with Claims Processing, Capitated Payment Reimbursement, or Member Enrollment and Management functions is required
Experience with Claims Processing/Adjudication Business Rules is required
5+ years of customer interfacing experience is required – project oversight, customer presentation
5+ years of experience in Access, Excel (Advanced), Visio and MS Project is required
5+ years of experience working as a Functional, Data or Business Analyst is required
5+ years of experience in Healthcare payer, Medicaid and/or Medicare is required
Agile software development process experience is required
Experience with at least one of the following:
PLEXIS Healthcare Systems software
Facets Claims software
QNXT Enterprise Core Administration Claims software

Knowledge, Skills and Abilities »

Interface/data mapping skills are required
EDI X12 skills are required
Strong development lifecycle and solution documentation skills are required
Ability to write SQL queries for data validation
Very analytical with problem-solving and conflict resolution skills
Excellent communication skills (written and verbal)


Job Responsibilities »

Work closely with the business and technical teams as a major contributor to the requirements specification deliverable, and write the business and functional requirements
Perform feasibility analysis, scope projects, and work with the project management team to prioritize deliverables and negotiate on product functionalities
Create detailed Business Requirement Documents (BRD) and translate into functional specifications
Provide analytic support by coordinating data extraction from various databases and data interpretation
Partner with development and analytic teams to provide reporting on software solutions
Participate in Integration Testing and User Acceptance Testing (UAT) and Functionality Testing