Job description

•    Exercises significant independent judgment within broadly defined policies and practices to determine best method for accomplishing work and achieving objectives.
•    May provide mentoring and guidance to lower-level employees.
•    Works closely with the implementation team to analyze and document clients business requirements and processes. Communicates these requirements by constructing configuration deliverables.
•    Creates test cases from functional requirements, executing test cases, and documenting results.
•    Participates in technical reviews and inspections to verify intent of change is carried out through the entire project.
•    Assists in coordinating business analyst tasks on information technology projects and provide support to other team members.
•    Provide accurate status and time reporting for project related tasks.
•    Medicaid Systems work experience.
•    Ability to exercise discretion and independent judgment.
•    Analyzes configuration data and structure to isolate defects.
•    Research and define solutions for new configuration, legislation, or client rules.
•    Creates proof of concept testing for new business processes or outcome requests.
•    Creates and presents solution, proof of concept, or testing results to customer.
•    Completes configuration within schedule timelines and configuration best practices.

    Qualifications

•    Bachelors degree or equivalent combination of education and experience.
•    Nine or more years of business analysis experience.
•    Openly and actively communicates information and takes initiative to communicate extensively.
•    Six 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.