Medicare Business Analyst

Role: Medicare Business Analyst/Domain Consultant

Location: Remote

Duration: Fulltime/Permanent

Note: SME knowledge on Medicare enrolment processing, which is one of the key requirements for this role, Eligibility and Billing are other key requirements.

Medicare BA Position Overview

The Business Analyst must be able to play a leadership role in managing and coordinating the members of the BIA team. They must have excellent interpersonal skills, be self-reliant and generate confidence to the extent that they can take increasing levels of personal responsibility in relation to delivering solutions directly to the client. They will be required to undertake project management duties and lead work streams, participate in RFP responses, Change request proposal development, Provide product demonstration and Perform user acceptance testing.

Experience and Education Requirements

• BA/BS degree in business/accounting/finance or equivalent experience.
• Thorough experience of Medicare Advantage health plan operations around Eligibility and Enrolment, CMS guidelines, Member correspondence, Medicare operations workflow, Premium billing and Capitation Revenue reconciliation
• 10+ years experience with customer relations activities, including business process management, issue management, ability to define desired outcomes, and solutions.
• 10+ years experience documenting requirements gathering sessions, processes, procedures, user manuals, and outcomes.
• 10+ year experience developing test criteria and executing the test process.
• Should have hands on experience writing basic SQL queries.
• Excellent organizational skills and attention to detail, with the ability to multi-task and prioritize.

Essential Duties and Responsibilities

• Interact with Clients; prepare a roadmap for Implementation of Software. Contribute in design related discussions.
• Issue analysis and escalation as per the process defines.
• Prepare Precise and detailed Functional Specification Documents, Requirement Specification documents, developing User stories and User Interface Guides
• Get sign off from the client on the requirements, functional specs. Review the configuration documents and transmit requirements to development team.
• Responsible for helping the development team to understand and clarify the functional requirements
• Define processes and procedures and assist with training other BIAs in their use.
• Work with delivery team to communicate business objectives and requirements, help make decisions on delivery options and effort estimations.
• Work with portfolio/project manager to plan analysis work and highlight risks and issues.
• Test, develop, and implement CMS information-based strategies to support new product development. Ensures issues are identified, tracked, reported on and resolved in a timely manner. Works with health plan clients to identify Change request. Adjust priorities according to changes in requirements and workload. Communicates needed changes to development team.
• Functional testing of software product and production approval. Testing the software as per client s requirement and ensure software movement to production.
• Mentor and groom other Business Analyst in the team
• Contribute to RFI/RFP responses