Senior Business Analyst with Claims - Remote with Travel

Remote • Posted 2 hours ago • Updated 2 hours ago
Contract Corp To Corp
Contract W2
Contract Independent
12 Months
Remote
$50/hr
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Fitment

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Job Details

Skills

  • Business Analyst
  • Medicaid
  • Medicare
  • SQL

Summary

     1. Candidate should have strong health care domain experience and should have good                  knowledge of Medicaid and Medicare.
  • 2. Candidate should have hands-on experience on claims processing and Adjudication processes.
  • 3. Must have good experience in Reference code/data sets required in Claims adjudication.
  • 4. Must have prior experience or understanding in configuring benefits or programs in claims system across various sub-systems.
  • 5. Should be able to run queries and perform basic system analysis, RCA etc.,
  • 6. Should work closely with the client and development team during the stages of development, and conduct demos at completion of milestone, track and close feedback from such demos
  • 7. Must have excellent written and spoken communication skills. Should be able to multitask between internal team and clients based on priority tasks
  • 8. Work Closely with Dev, architecture and Design teams to define the GUI view and platform requirements, which is the foundation of the product.
  • 9. In depth understanding of Claims and Claims lifecycle:
  • Member
  • Provider
  • Claim submission – Paper and EDI X12
  • Adjudication
  • Payment Cycle (Finance)
  • Reporting
  • 10. Claim Types:
  • Professional
  • Dental
  • Institutional
  • Pharmacy
  • Encounters and Capitation
  • 11. Claim Formats:
  • EDI X12 formats like 837P/I/D
  • X12 formats 835, 834, 270/271, 276/277
  • 12. Claim System:
  • Familiarity with systems like CMdS, GHS, Facets and etc
  • Technical Skills
  • SQL: To validate data in backend tables (e.g., claim status, payment details, find members/providers, Benefit Plan).
  • EDI Tools: Validating X12 files.
  • Interface Testing: Understanding how data flows between systems and formats and use tools like postman
  • Preferred skills:
  • Minimum of 8+ years of experience in health care experience especially in MMIS domain.
  • Capability to think out-of-the-box to create new solutions as needed.
  • Ability to validate Test scenarios and test plans, test data.
  • Should be able to Review requirements, documentation and create Requirements Traceability matrix (RTM)
  • Should have excellent communication (written and spoken ) skills to engage with different stake holders like QA/dev team, clients, end users of Clients and Business Units.
  • Ability to assess current functionality available in a product vis a vis market trends, regulatory requirements to be implemented in future version of the product.
  • Ability to drive and share the requirements with Technical and Architects regarding
  • product features to be implemented.
  • Communication: Collaborate with cross-functional teams
Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.
  • Dice Id: 91139083
  • Position Id: 26-00328
  • Posted 2 hours ago

Company Info

About The Dignify Solutions, LLC

 The Dignify Solutions with Global Capabilities and Local Excellence – has combined experience of 30 +years in Client Services/ Engagement/ Relationship/ Partnership, Sales/ Account Management, Service Delivery, Recruiting, Staffing and Talent Acquisition for the whole gamut of skillsets in Information Technology (Digital Transformation, Artificial Intelligence, Machine Learning and other business domains).

The Dignify is dedicated to meeting the needs of two types of customers: our Clients and our Consultants. We ensure that our clients receive Top Talent while also allowing our consultants to accomplish their Professional Goals. 

The Dignify honors & prioritizes the Philosophy of Client Centricity and Delivery Excellence. The Dignify has dedicated Sales and Delivery Teams with each client, to make sure our standards and yours are being met. From Banking and Financial Services, Manufacturing and Retail, Energy and Utilities, Communication and Media, Technology and Telecom Services and beyond, our goal is to maintain a High Quality, Customer-Focused Engagement Model.

We are driven by three core principles in changing Staff Augmentation for the better: Cost, Quality, and Responsiveness. Whatever your need – be it a single resource or a whole team, we will find you the right talent in a timely and cost-effective manner.

The Dignify offers the Best Skilled Potential Talent, Services and Solutions to help our clients, accomplish their goals. As Market Intelligence Leaders, we provide insight into industry factors that will give you the competitive advantage you need to stay a step ahead of others in your space.

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