Business Analyst with Medicaid/ Medicare/ MMIS Expertise

Role: Business Analyst with Medicaid/ Medicare/ MMIS Expertise

Candidate should have strong healthcare domain experience and should have good knowledge of Medicaid and Medicare.

Hands-on experience in claims processing and Adjudication processes.

Experience in Reference code/data sets required in claims adjudication.

Prior experience or understanding in configuring benefits or programs in the claims system across various sub-systems.

Should be able to run queries and perform basic system analysis, RCA, etc.

Should work closely with the client and development team during the stages of development, and conduct demos after milestones, track and close feedback from such demos

Work closely with Dev, architecture, and Design teams to define the GUI view and platform requirements, which is the foundation of the product.

In-depth understanding of Claims and Claims lifecycle

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 using tools like Postman