Consulting Manager

As a Healthcare Consultant Manager, candidate should have experience with Assessments and Discoveries

i. Current-state analysis (functional landscape (detailed), technical landscape (high-level)) and future-state definition (including study of Industry best practices, benchmarking, gap analysis)

ii. Delivery of Recommendations and Implementation Roadmap – as outputs from the Assessment / Discovery exercise – for the actual Technical Remediation, next steps

iii. Support to documentation work (including Statements of Work (SoWs)) for Discovery / Assessment phase, and for Implementation phase

iv. Proficiency with MS Office suite – especially, PowerPoint (then, Word and Excel)

v. Solutioning in proposals (proactive, reactive (RFX responses))

USA Healthcare Payer, USA Health Insurance, Healthcare Domain Consulting (Consultant) / Healthcare Industry Consulting(Consultant), USA Healthcare IT, Core Administration, Claim Processing, Membership Enrollment, Discovery (Discoveries),Assessment(s), HIPAA, Affordable Care Act (ACA), Medicare, Medicaid, Commercial Healthcare Business Analysis (Analyst), Healthcare Product Owner (Manager), Certifications in Business Analysis (like CBAP from IIBA, etc.), Healthcare Certifications from AHIP, AHM

Desirable work experience

1.As a Healthcare Business Analyst, has the candidate done Requirements Mgmt.

i. Requirements definition, requirements elicitation / gathering

ii. BA involvement in Joint Application Development (JAD) sessions

iii. Requirements Traceability Matrices (RTMs) – end-to-end ownership

iv.MS Visio diagrams, other unified modeling language (UML) diagrams, process-flow diagrams v. Proficiency with Water-fall and / or Agile methodology (methodologies)

2. As a Product Owner / a Product Manager, has the candidate been hands-on on

i. Product roadmap

ii. Product backlog

iii. Epics and user stories

iv. Healthcare user-interface (screen) needs and healthcare data-management (database) needs

Other Expectations

1.Healthcare Payer Functions and Business Processes – Strong Knowledge in i, ii,, iii, viii (below) –

Augmented by good knowledge / understanding in other areas (below):

i) Claim Processing, Core Administration

ii) Membership Enrollment

iii) EDI Transactions (HIPAA X12 5010 – 8X, 27X)

iv) Risk Mgmt., Quality Mgmt.

v) Care Management

vi) Member services (E2E member management)

vii) Provider services (E2E provider management)

viii) Lines of Business (LoBs) – Commercial, Medicare, Medicaid, Duals, Exchanges

2.Any Relevant Certifications

i) Healthcare Certifications (PAHM, FAHM, others) from AHIP, AHM

ii) FHIR (good to have); HL7 (“could be considered”)

iii) Business Analysis Certifications from IIBA – ECBA, CBAP

iv) CSPO