Healthcare Technical Business Analyst (Medicaid/Medicare, Claims, Healthcare Payer experience Must)

Job Description:

Job Title: Technical Business Analyst
Location: Hybrid Remote (any Infinite or Client's office Location at least once in a week or a minimum of 3 days per month)
Type: Full Time/W2 with Infinite Computer Solutions

Responsibilities:

• Must have very good understanding of the healthcare payer space with a minimum experience of 5-8+ years in the domain.
• Must have a prior experience in implementing/maintenance of commercial payer claims solution and/or Medicare/Medicaid system
• Must have good experience with claims processing concepts, along with the provider, member enrolment and care management concepts.
• Must have good experience in Reference code/data sets required in Claims adjudication including not limited to CPT, CDT, HCPCS, ICDs.
• Must have prior experience or understanding in configuring benefits or programs in claims system across various sub-systems.
• Must be able to work with the clients to create/gather requirements and document them according to standards.
• Must adhere to (or if needed, define) the processes for requirement solicitation, documentation and hand off.
• Should work closely with the IT development team to elucidate the requirements, enable constructive discussions / brainstorming sessions to implement the best in class solution.
• Should have basic understanding concepts like web services, relational databases etc.,
• Should be able to run queries and perform basic system analysis, RCA etc.,
• Should be able to create mapping documents for the various interfaces and include business rules, transformation and DB mapping.
• 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
• Must have excellent written and spoken communication skills. Should be able to multitask between internal team and clients based on priority tasks
• Work Closely with Dev, architecture and Design teams to define the GUI view and platform requirements, which is the foundation of the product.

Preferred skills:

• Capability to think out-of-the-box to create new solutions as needed.
• Prior experience as a IT QA or Developer in a healthcare system would be helpful though not mandatory.
• 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.

Optional Tools usage:

• MS Visio to define the different views like System, technical, functional and role based view.
• Awareness defect tracking and version control tools like Jira, TFM, DevOps Azure
• DB client to write data queries to validate data updated in the database table.