Job
Description
Job Description: Experience: 6-11 Years Location: On-site About the Role: We are seeking an experienced and highly motivated Business Analyst to join our on-site team. The ideal candidate will possess a strong background in healthcare IT, specifically within the U.S. Medicaid domain, and demonstrate a deep understanding of configuration implementation, data analysis, and client requirement documentation. This role requires a professional who can bridge the gap between business needs and technical solutions, ensuring accurate and efficient system configuration and data management. Responsibilities: Analyze and document complex client business requirements and processes, effectively communicating these to technical personnel. Construct comprehensive configuration deliverables, ensuring alignment with client needs and technical capabilities. Adhere to and champion the Configuration team's approach, principles, methodologies, and best practices. Conduct in-depth analysis of configuration data and structures to identify, isolate, and resolve defects. Lead and participate in Configuration Implementation Build and Maintenance activities. Research, define, and propose solutions for new configuration requirements, legislative changes, or evolving client rules. Develop and modify system requirements documentation to accurately reflect client needs and system design. Collaborate with clients in meetings to gather and document requirements, exploring potential solutions and addressing concerns. Assist in creating robust test scenarios to validate that client requirements are fully incorporated into the system design and functionality. Process Medicaid claims and troubleshoot adjudication results, providing expert analysis and solutions. Required Skills and Experience: 6-11 years of proven experience as a Business Analyst, preferably within the healthcare or managed care industry. Demonstrated experience with Configuration Implementation Build & Maintenance. Proficiency in configuring systems such as QNXT or FACETS. Strong understanding of Medicaid Program structures, including carriers, programs, benefit plans, policy, policy plans, sponsors, and policies. In-depth knowledge of Provider data, including contract and pricing configurations. Comprehensive understanding of Member data, encompassing aid categories, coverage codes, benefit packages, restrictions, limitations, prior authorizations, programs, and primary care providers. Solid grasp of relational database concepts and schemas. Proficiency in writing SQL queries for data analysis and troubleshooting. Direct experience with processing Medicaid claims and the ability to effectively troubleshoot adjudication results. Excellent analytical, problem-solving, and communication skills. Ability to work independently and collaboratively in a fast-paced, on-site environment. Preferred Qualifications: Business analysis experience specifically within U.S. Medicaid management.
