Configuration Analyst (US Healthcare / Medicaid) - QNxt

Summary

Gain well Technologies is the leading provider of technology solutions that are vital to the administration and operations of health and human services programs. We are a new company (divested from DXC Technologies) with over 50+ years of proven experience, a reputation for service excellence and unparalleled industry expertise with approximately $1+ billion dollars of revenue, 8,000+ employees who support clients across 41 U.S. states and territories with offerings including Medicaid Management Information Systems (MMIS), fiscal agent services, program integrity, care management, immunization registry and eligibility services. We offer our clients scalable and flexible solutions for their most complex challenges.

These capabilities make our company a trusted partner for organizations seeking reliability, innovation and transformational outcomes. About 49M Medicaid beneficiaries are being supported. 1.3B immunization records are maintained by engaging 3.0 M providers. Our commitment to clients, drives continuous improvement in the quality of healthcare for beneficiaries nationwide through vital healthcare technology.

Your role in our mission

Play a critical part in ensuring Gainwell is meeting our clients objectives in important areas.

• Help coordinate a business analyst teams duties and activities on IT projects and nurture newer team members by providing guidance and support
• Be a knowledgeable bridge between clients, project managers and technical staff to define, document and share business requirements and expected impact
• Work with the client to develop business specs at the start of a technical project
• Analyze, plan, design, document or make recommendations to improve business processes to support clients technology goals
• Help verify that all requirements have been met by approving and validating test results
• Exercise your ability to use basic analytical or relational database software such as Excel or SQL to quantify the anticipated impact of work

What we're looking for

Qualifications

• Bachelor's degree or equivalent combination of education and experience.
• 6 or more years of business analysis experience.
• Openly and actively communicates information and takes initiative to communicate extensively.
• 3 or more years experience configuring in QNXT or FACETS:
• Contracts/benefits.
• System data points needed for successful X12 transactions, Claim Adjustment Reason Codes and Remittance Advice Code.
• Contracts for provider services, benefits for member coverage, fee schedules, capitation, and claim editing enforcement.
• Understands Medicaid Program structure in carriers, programs, benefit plans, policy, policy plans, sponsor, and or policies.
• Understands Provider (Contract and Pricing) data including but not limited to provider type, specialty, taxonomy, enrolment impacts, service locations, certifications and licensing, affiliations, and reimbursement impacts.
• Understands Member data including but not limited to aid categories, coverage codes, benefit packages, restrictions, limitations, prior authorizations, programs, and primary care providers.
• Experience with Configuration Implementation Build & Maintenance.
• Experience working with complex systems at a detailed level.
• Experience working in a virtual team environment performing self-directed tasks.
• Understands relational database concepts and schemas.
• Experience writing SQL queries for data analysis.
• Experience working with Medicaid/MMIS systems.
• Preferred experience includes DDI (Design, Development, and Implementation) and operations phases.
• Experience processing Medicaid claims and ability to troubleshoot adjudication results.
• Demonstrated aptitude for learning new technologies and keeping current with industry best practices.
• Experience with Requirement Traceability Matrices.
• Ability to multi-task and maintain organization in a fast-paced environment.
• Ability to create and maintain highest levels of confidentiality when dealing with proprietary or private information.
• Ability to exercise sound judgment and make decisions in a manner consistent with the essential job function.
• Preferred experience working with HP Application Lifecycle Management (ALM).

Other Qualifications

• Interpersonal skills to interact with customers and team members.
• Regular and reliable attendance is an essential function of the position.
• Handles difficult situations diplomatically.
• Good written and verbal communication skills to ensure clarity.
• Good analytical and problem-solving skills.
• Highly proficient in the use of Microsoft Office Products (PowerPoint, Excel, Word. Visio, Outlook).
• Presentation skills to present to management and customers.
• Ability to work as a team and independently.
• Adaptable to changing priorities.
• Ability to manage multiple priorities ensuring deadlines are achieved.
• Team and goal orientated.
• Ability to work in a remote environment and be self-directed with minimal supervision.