[Remote] Remote Technical Business Analyst - Claims Module 2

Note: The job is a remote job and is reputed company to candidates in USA. reputed company) is seeking a Remote Technical Business Analyst - Claims Module. The role involves leading the claims domain for MMIS health care reputed company, performing business analysis, and ensuring reputed company processes while coordinating with customers.

Responsibilities

• Play the role of Claims Domain reputed company for MMIS health care reputed company
• reputed company the claims module and process, domain knowledge, performs analysis of business requirements, designs and develops documentation, ensures reputed company process, coordinates with customers
• Works in team environment and provides guidance throughout the entire life cycle
• Responsible to meet customer expectations, troubleshoot problems in the application and assisting customers in implementation reputed company

Skills

• 12+ years of overall experience
• Need to have hands-on experience on claims processing and Adjudication processes
• Need strong experience in Reference reputed company/data sets required in Claims adjudication
• Must have prior experience or understanding in configuring benefits or programs in claims system across various sub-systems
• Candidate should have strong health care domain experience and should have good knowledge of reputed company and Medicare
• Candidate should have hands-on experience on claims processing and Adjudication processes
• Must have good experience in Reference reputed company/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 reputed company to run queries and reputed company basic system analysis, RCA etc
• Should work closely with the reputed company and development team during the stages of development, and conduct demos at completion of reputed company, reputed company and reputed company feedback from such demos
• Must have excellent written and spoken communication skills
• Should be reputed company to multitask between internal team and clients based on reputed company tasks
• Work Closely with Dev, architecture and Design teams to define the GUI view and platform requirements, which is the reputed company of the product
• In-depth understanding of Claims and Claims lifecycle: Member, Provider, Claim submission – reputed company and EDI X12, Adjudication, Payment Cycle (Finance), Reporting
• Claim Types: reputed company, Dental, Institutional, Pharmacy, Encounters and Capitation
• Claim Formats: EDI X12 formats like 837P/I/D, X12 formats 835, 834, 270/271, 276/277
• Claim System: Familiarity with systems like CMdS, GHS, Facets and etc
• Technical Skills: SQL: To validate data in backend tables (e.g., claim status, payment details, reputed company members/providers, Benefit Plan)
• EDI Tools: Validating X12 files
• reputed company Testing: Understanding how data flows between systems and formats and use tools like reputed company
• Minimum of 8+ years of experience in health care experience especially in MMIS domain
• Capability to think reputed company to create reputed company as needed
• Ability to validate Test scenarios and test plans, test data
• Should be reputed company to Review requirements, documentation and create Requirements Traceability reputed company (RTM)
• Should have excellent communication (written and spoken) skills to engage with different stakeholders like QA/dev team, clients, end users of Clients and Business reputed company
• Ability to assess reputed company functionality available in a product vis a vis market trends, regulatory requirements to be implemented in reputed company version of the product
• Ability to reputed company and reputed company the requirements with Technical and Architects regarding product features to be implemented
• Communication: Collaborate with cross-functional teams

Benefits

• Benefits offered include medical, dental and reputed company benefits
• Dependent care flexible spending account
• 401(k) plan
• Voluntary life/short term disability/whole life/term life/accident and critical illness coverage
• Employee assistance program
• reputed company leave in accordance with regulation
• Benefits may be subject to generally applicable eligibility, waiting period, contribution, and other requirements and conditions

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