DescriptionClaims Module Senior Business Analyst
About the Role
This individual will play the role of Claims Domain lead for MMIS health care projects
Responsibilities
- Drive the claims module and process and provide domain knowledge
- Perform analysis of business requirements
- Design and develop documentation and ensure quality process while coordinating with customers.
- Work in a team environment and provide guidance throughout the entire life cycle.
- Responsible for meeting customer expectations and troubleshooting problems in the application.
- Assist customers in implementation decisions.
Requirements
- Candidate should have strong health care domain experience and should have good knowledge of Medicaid and Medicare.
- Candidate should have hands-on experience on claims processing and Adjudication processes.
- Must have good experience in Reference code/data sets required in Claims adjudication.
- Must have prior experience or understanding in configuring benefits or programs in 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 at completion of milestones, track and close feedback from such demos
- Must have excellent written and spoken communication skills. Should be able to multitask between internal team and clients based on priority tasks
- Work Closely with Dev, architecture and Design teams to define the GUI view and platform requirements, which is the foundation of the product.
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In depth understanding of Claims and Claims lifecycle:
Member, Provider, Claim submission – Paper and EDI X12, Adjudication, Payment Cycle (Finance), Reporting
- Claim Types: Professional, Dental, Institutional, Pharmacy, Encounters and Capitation
- Claim Formats: EDI X12 formats like 837P