Business Analyst (US Healthcare / Medicaid) - QNXT

Summary

Gainwell Technologies is the leading provider of technology solutions that are vital to the administration and operations of health and human services programs. We are a new company (divested from DXC Technologies) with over 50+ years of proven experience, a reputation for service excellence and unparalleled industry expertise with approximately $1+ billion dollars of revenue, ~8,000+ employees who support clients across 41 U.S. states and territories with offerings including Medicaid Management Information Systems (MMIS), fiscal agent services, program integrity, care management, immunization registry and eligibility services. We offer our clients scalable and flexible solutions for their most complex challenges.
 
These capabilities make our company a trusted partner for organizations seeking reliability, innovation and transformational outcomes. About 49M Medicaid beneficiaries are being supported. 1.3B immunization records are maintained by engaging 3.0 M providers. Our commitment to clients, drives continuous improvement in the quality of healthcare for beneficiaries nationwide through vital healthcare technology.
 

Your role in our mission

Summary

The primary responsibility of a Sr. Business Analyst 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.

What we're looking for

Qualifications

• Bachelor's degree or equivalent combination of education and experience. 
• 6+ 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.
• Experience with Requirement Traceability Matrices.
• Ability to multi-task and maintain organization in a fast-paced environment.
• Ability to create and maintain highest levels of confidentiality when dealing with proprietary or private information.
• Ability to exercise sound judgment and make decisions in a manner consistent with the essential job function.
• Preferred experience working with HP Application Lifecycle Management (ALM).

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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