Senior Professional Business Analyst

Summary

Summary

The primary responsibility of a Sr. Business Analyst (QNXT/Facets) is to analyze and document business processes, gather and define requirements, and collaborate with stakeholders to ensure the successful implementation of solutions that meet the unique challenges and requirements of the healthcare industry. The successful candidate will be an intellectually curious, self-directed individual with excellent organizational skills and attention to detail. This role is highly collaborative in nature providing support for IT and business teams. Performs complex analyses of State Medicaid Policies, and Legacy System business rules from data extracts.

Your role in our mission

Key Responsibilities

•    Analyzes client requests for proposals and applies advanced subject matter knowledge to solve complex business issues and is regarded as a subject matter expert.
•    Adheres to and supports Configuration team approach and other configuration principles, methodologies, and practices.
•    Ensures communication among all key stakeholders.
•    Exercises significant independent judgment within broadly defined policies and practices to determine best method for accomplishing work and achieving objectives.
•    May provide mentoring and guidance to lower-level employees.
•    Works closely with the implementation team to analyze and document client's business requirements and processes. Communicates these requirements by constructing configuration deliverables.
•    Creates test cases from functional requirements, executing test cases, and documenting results.
•    Participates in technical reviews and inspections to verify 'intent of change' is carried out through the entire project.
•    Assists in coordinating business analyst tasks on information technology projects and provide support to other team members.
•    Provide accurate status and time reporting for project related tasks.
•    Medicaid Systems work experience.
•    Ability to exercise discretion and independent judgment.
 

What we're looking for

Qualifications

•    Bachelor's degree or equivalent combination of education and experience. 
•    Six or more years of business analysis experience.
•    Openly and actively communicates information and takes initiative to communicate extensively.
•    Four or more years’ experience configuring in QNXT or FACETS:
                 Contracts/benefits.
                 System data points needed for successful X12 transactions, Claim Adjustment Reason Codes and Remittance Advice Code.
        Contracts for provider services, benefits for member coverage, fee schedules, capitation, and claim editing enforcement.
•    Understands Medicaid Program structure in carriers, programs, benefit plans, policy, policy plans, sponsor, and or policies.
•    Understands Provider (Contract and Pricing) data including but not limited to provider type, specialty, taxonomy, enrolment impacts, service locations, certifications and licensing, affiliations, and           reimbursement impacts.
•    Understands Member data including but not limited to aid categories, coverage codes, benefit packages, restrictions, limitations, prior authorizations, programs, and primary care providers.
•    Experience with Configuration Implementation Build & Maintenance.
•    Experience working with complex systems at a detailed level.
•    Experience working in a virtual team environment performing self-directed tasks.
•    Understands relational database concepts and schemas.
•    Experience writing SQL queries for data analysis.
•    Experience working with Medicaid/MMIS systems.
•    Preferred experience includes DDI (Design, Development, and Implementation) and operations phases.
•    Experience processing Medicaid claims and ability to troubleshoot adjudication results.
•    Demonstrated aptitude for learning new technologies and keeping current with industry best practices.
 

What you should expect in this role

• Fast paced, challenging and rewarding work environment.
• Work life balance.    
• Hybrid Office environment.
• Will require late evening work to overlap US work hours.

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