Job Description :
6 months

Phone and skype

Remote

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Facets Claims Editing BA
Senior Claims Editing Solutions Analyst- Sr.Technical BA

Certification:

ul>
li>Certified Medical Coder (CPC)and/or equivalent coding/billing certification isREQUIRED/li>
/ul>

Education:

ul>
li>Bachelor’s degree or equivalent years of relevant work experience is required/li>
li>Minimum of five (5) years of health plan experience to include three (3) years of requirements definition, system configuration, or testing experience is required/li>
li>Experience in creating and writing technical specifications within an agile framework: Epics, Story, Task, is required/li>
li>Experience in continuous delivery software development lifecycles is preferred/li>
/ul>

Responsibility:

ul>
li>Manage and define system configuration requirements for complex system solutions including company-wide programs and projects/li>
li>Recognize inconsistencies and gaps in a complex business process/li>
li>Develop and utilize reports to analyze and stratify data in order to address gaps and provide answers to issues identified within the department or by other departments/li>
li>Responsible for requirements, definition, documentation, design, testing, training and implementation support using appropriate templates or analysis tools/li>
li>Work with stakeholder to develop a business case including return on investment, soft benefits, and any regulatory/compliance issues/li>
li>Identify, manage and document the status of open issues, configuration design, and final resolution within change management system/li>
li>Review and interpret regulatory items, timely delivery of required updates/li>
li>Plan and implement new software releases including requirements definition, testing, and training/li>
li>Maintain the group focus, leads the discussion toward stated goals and manages the group dynamics in facilitation requirements gathering sessions/li>
li>Review vendor supplied user, administration and training documentation for improvements and impacts to systems and processes/li>
li>Provide guidance to other Claims Editing Solutions Analysts/li>
li>Participate in meetings with business owners, users and IT to achieve solutions that meet the requirements and expectation of client /li>
li>Lead configuration initiatives in payment policy meetings and present to committees/li>
li>Coordinate annual coding and benefit changes with internal resources/li>
li>Provide analysis of efficiencies related to system enhancement and automation; review, analyze, and document effectiveness and efficiency of existing systems and develop strategies for improving or further leveraging systems/li>
li>Development of standard code set and reimbursement design templates/li>
li>Manage the reimbursement review; identify and design appropriate change; lead the development and execution of test plans and scenarios for all reimbursement designs for core business system and related processes/li>
li>Audit configuration to ensure accuracy and internal controls to minimize fraud and abuse and overpayment related issues/li>
li>Anticipate and identify customer needs and match products and services to facilitate the fulfillment of those needs/li>
li>Ensure system processes and documents exist as basis for system logic/li>
li>Manage resources and communications to facilitate work completion/li>
li>Mentor the use of tools to define requirements and test plans and scenarios for complexity system changes/li>
li>Perform any other job related instructions as requested/li>
/ul>

Required Knowledge/Skills:

ul>
li>Exceptional computer skills and abilities inClinical Editing and Facets/li>
li>In-depth understanding of coding and billing, managed care benefit/claim reimbursement methodology/li>
li>Advanced proficiency Microsoft Suite to include Word, Excel, Access and Visio/li>
li>Knowledge and familiarity of Facets/li>
li>Understanding of database relationships required/li>
li>Understanding of DRG and APC reimbursement methods/li>
li>Understanding of CPT, HCPCs and ICD-CM Codes/li>
li>Knowledge of HIPAA Transaction Codes/li>
li>Effective listening and critical thinking skills/li>
li>Effective problem solving skills with attention to detail Excellent written and verbal communication skills/li>
li>Ability to work independently and within a team environment/li>
li>Strong interpersonal skills and high level of professionalism/li>
li>Ability to develop, prioritize and accomplish goals/li>
li>Understanding of the healthcare field and knowledge of Medicaid and Medicare/li>
li>Proper medical coding knowledge and claims processing skills/li>
li>Proficient in Agile story writing using standard industry formats/li>
li>Proficient in Test Case and Test Scenario writing, using standard industry formats/li>
li>Customer service oriented/li>
li>Ability to manage vendor, state and federal regulatory relationships/li>
li>Effective identification of business problems, assessment of proposed solutions to those problems, and understanding of the needs of stakeholders/li>
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