Business Analyst - Medicaid and Claims -Remote with Travel

Remote • Posted 1 day ago • Updated 7 hours ago
Contract Corp To Corp
Contract W2
Contract Independent
12 Months
Remote
Depends on Experience
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Job Details

Skills

  • BA
  • Medicaid
  • MMIS/ MES
  • Claims
  • Finance
  • CMds

Summary

 

Required qualifications

  • 12+ years business analysis experience in Medicaid MMIS / MES, with deep hands-on work in at least two of: Claims, Member/Eligibility-Enrollment, Finance/Financial Accounting.
  • Proven experience developing and implementing claims systems / MMIS / MES platforms, such as CMds, Health Enterprise, QNXT, Facets, or comparable commercial Medicaid/claims suites.
  • Experience modernizing or replacing legacy MMIS (COBOL/mainframe or equivalent) with a commercial Medicaid platform.
  • Strong Medicaid domain knowledge, including:
  • o FFS vs managed care; capitation vs ASO / administrative services models
  • o Claim types, media sources, edits/EOBs, adjustments/voids, Medicare crossover, encounters
  • o Aid categories, benefit packages, eligibility spans, timely filing, TPL concepts
  • o Provider payments, remittance advice, budget/object codes, COS, fund source / FFP concepts
  • o CMS / state Medicaid policy drivers relevant to MES implementation and certification
  • Demonstrated ability to write clear functional design and acceptance criteria for complex adjudication and financial rules.
  • Experience working embedded with development and QA teams in Agile or hybrid SDLC.
  • Excellent facilitation, documentation, and stakeholder communication skills.
  • Preferred qualifications
  • Hands-on CMdS configuration or implementation (Claims, Member, Finance, Reference, Service Auth).
  • Familiarity with HIPAA X12 (837/835), COBA/crossover, EVV-related claim flows.
  • Experience supporting CMS MES certification artifacts and evidence packages.
  • Prior lead BA experience on multi-module MES releases.

 

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: 26-00569
  • Posted 1 day 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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