DUTIES AND RESPONSIBILITES:
• Responsible for elicitation, analysis, and documentation of business requirements.
• Research and exploration of user requirements, costs, and benefits in support of documentation required for the demand management process.
• Responsible for analyzing the business needs to identify new processes and process improvements that will meet those needs.
• Documents current business processes and models to define requirements and/or gaps.
• Analyze detailed system factors including input/output requirements, information and paper flow, hardware, and software needs.
• Analyze “soft" system factors including roles, responsibilities, policy, culture, etc.
• Evaluate the impact of potential software and process changes on the organization.
• Develop and facilitate groups as necessary in pursuit of eliciting and defining requirements.
• Assist in the creation of the business case documentation.
• Understanding of architectural consistency and usability standards.
• Defines and develops user test cases and validates test results during testing.
• Executes unit and functional test cases.
• May conduct system demonstrations and training sessions, as well as participate in design/review of training content.
• Plays a third level support role by helping to troubleshoot and resolve issues with production systems.
• Participates in associate meetings and communicates any concerns to management.
QUALIFICATIONS AND REQUIREMENTS:
• Bachelor’s degree in computer science, Information Systems, Business, or another related field or equivalent work experience.
• Proven experience leading data migration requirements from legacy systems into a new ERP (Sage X3) environment
• Strong hands-on expertise in requirements elicitation, documentation, and management, with emphasis on data mapping, transformation rules, and validation
• Deep understanding of data structures, data quality, and migration best practices, with the ability to identify gaps and risks early
• Self-driven and accountable professional with strong stakeholder management and communication skills, able to drive outcomes with minimal oversight
• Working knowledge of Confluence and JIRA.
• Experience in any of the following business areas is desired: Sales operations, order entry, accounting, finance, procurement, warehouse operations, order management, and order fulfillment.
• Minimum of 3-5 years’ business analysis or systems analysis experience is preferred.
• Bonus: Sage X3 experience (ERP).
Associate is expected to operate at a proficient level across the following areas of technical knowledge and skill:
• Ability to organize and prioritize work.
• Detail oriented, proactive, creative, and efficient
• Intermediate level abilities in Excel, Outlook, PowerPoint, Visio, and Word
• Familiarity with application integration methods to include understanding of data mapping process.
• Ability to effectively work both independently and collaboratively in a team environment
• Ability to work on simultaneous and complex projects, with domain expertise in at least one business area.
• Expertise in ERP solution selection and implementation is a plus
• Ability to communicate effectively to both technical and non-technical audiences in written and non-written format
• Ability to work with all levels of associates
• Ability to work with minimal supervision in a very dynamic environment
• Ability to learn new systems and tools
• Knowledge of software development life cycle methodologies, processes, and procedures.
• Active listener
• Effective in a variety of formal/informal presentation settings: one-on-one, small, and large groups.
Job Title: Business Analyst
Location: REMOTE (SC Resident)
Duration: 12 Months
- This position requires an individual with strong analytical skills and experience in:
- Managing multiple work efforts simultaneously
- Medical Coding
- Time management skills
- CPT/HCPCS and ICD-10 translation
- Ability to write and understand business and functional requirements.
- Medicaid Policy, coding changes, system functionality and success implementation of changes for the expected outcome
- Please ensure that your candidates have strengths in these areas. Please do not submit general Medical Coders with no structured background in business rules or claims processing, preferably Government Operations and Managed Care background.
- The candidate must have strong collaboration and relationship building skills.
- Experience in healthcare insurance.
Scope of the project:
This project is an immediate support need that will primarily focus on providing consulting services to operations and policy staff for the current medical coding federal requirements, quarterly and intermittently, and all coding changes associated with agency initiatives to ensure compliance policy and code change alignment. Note - Medicaid Management Information System (MMIS) is the system of record.
The current position’s focus and priority is the continued support of serving as a subject matter expert (SME), utilizing knowledge of medical coding and MMIS to support change requests while ensuring change requests and system updates result in the expected claims adjudication outcomes for the benefit of Medicaid members and providers.
Objectives to be fulfilled by candidate:
The principal duties of this position are to assist with the CPT/HCPCS and ICD-10 code maintenance.
Specific duties include, but are not limited to:
- Collaborates with internal recipient and owner of initial review of codes to determine scope of changes for planning and timely completion.
- Receives listings of codes changes distributed to the Reference Administration and Medicaid Program staff for review and analysis.
- Serves as an approver within the code change / update process following the internal initiation of annual (and quarterly) updates from CMS of all ICD-10, CPT/HCPCS coding changes.
- Serves as lead for meetings with Agency personnel, stakeholders, and process owners.
- Serves as an agency subject matter expert (SME) for medical coding methodologies, Medicaid policy, and related topics.
- Researches business rules, requirements, and models to complete initial analysis and recommendations.
- Maintains business rules, requirements, and models in a repository.
- Collaborates with team to ensure process documentation is complete, owner and stakeholder, as needed, training content is complete and routinely updated.
- Participates in agency projects and related initiatives requiring subject matter expertise.
- Other duties, as assigned or required.
Required skills (rank in order of importance):
- 5 years’ experience in healthcare insurance; medical review, program integrity, or appeals.
- 5 years’ experience working with IT developers/programmers in a payor environment.
- 5 years’ experience Medical Coding in payer environment.
- 3 years’ clinical experience in a healthcare environment (Strong clinical assessment and critical thinking skills.)
- 5 years’ strong knowledge of ICD/CPT/HCPCS translation and coding methodologies.
Preferred skills (rank in order of importance):
- 5 years’ experience in policy remediation.
- 5 years’ Medical Claim processing systems experience.
- Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and / or other medical coding software programs).
Required education:
Bachelor’s degree in Health Information, Healthcare Administration, or related field; equivalent experience may be considered with a minimum of 3+ years of direct supervisor experience.
Additional skills/duties:
- Superb written and oral communications skills, strong proficiency in English.
- Strong knowledge of formal business process documentation.
- Ability to effectively communicate with executive management, line management, project management, and team members.
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