Job Description :
Healthcare Business Analyst translates business needs into clearly defined and documented detailed, high quality requirements and/or supplemental specifications for new applications or analyzes change requests/enhancements in existing applications.
Analyzes data to determine business problems.
Handles information including patient services and how the services are paid after conducting investigations and pursuing recoveries through contact with various parties.
Works collaboratively within or outside the team to identify charge system weakness, to recommend changes and focused education.
Will also ensure adherence to compliance policies and contracts. Knowledge and experience of Medicare & Medicaid.
7+ years of experience working in an operations role at a health plan
4+ years of Healthcare experience in any of the following:
Government Programs, Core Administer Delivery, Program Management, Product Management, or Network Management
2+ years of experience in one or more of the following:
Operational business process improvement, business process analysis, benchmark analysis or workflow analysis
Ability to work on claims with different LOBs such as Commercial, Medicare, Medicaid etc.
Knowledge and experience of Medicare & Medicaid state level reporting levels
Strong Knowledge/Experience with Dimensional Modeling
Strong understanding of healthcare data formats, standards, and can map them to CMS and state level reporting needs
Good understanding on the lifecycle of claims adjudication
Possess good exposure on the various claim functionalities such as Edits, COBs, claims adjustments, Episodes etc.
Preferred.
Experience working with Medicare, Medicaid Blues organization(MCO)
Understanding of Medicare Part A,B
Understanding of handling claims population for Dual eligible populations
Knowledge of Medicare/Medicaid reimbursement methodology(PPS/DRG)