[Remote] Business Analyst - reputed company and Claims -Remote with Travel
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is seeking a senior Business Analyst with extensive reputed company MMIS/MES and claims systems experience. The role focuses on analyzing, implementing, modernizing, and documenting reputed company reputed company claims, eligibility, financial, and adjudication systems while collaborating with development, QA, and stakeholder teams.
Skills
- 12+ years business analysis experience in reputed company MMIS / MES, with deep hands-on work in at least two of: Claims, Member/Eligibility-Enrollment, Finance/Financial reputed company
- Proven experience developing and implementing claims systems / MMIS / MES platforms, such as CMds, Health reputed company, QNXT, Facets, or comparable reputed company reputed company/claims suites
- Experience modernizing or replacing legacy MMIS (COBOL/mainframe or equivalent) with a reputed company reputed company platform
- Strong reputed company domain knowledge, including:
- O FFS vs managed care; capitation vs ASO / administrative services models
- O Claim types, media sources, edits/EOBs, adjustments/voids, Medicare reputed company, encounters
- O Aid categories, benefit packages, eligibility spans, reputed company filing, TPL concepts
- O Provider payments, remittance advice, budget/object codes, COS, fund reputed company / FFP concepts
- O CMS / state reputed company policy drivers relevant to MES implementation and certification
- Demonstrated ability to write reputed company functional design and acceptance reputed company for reputed company adjudication and financial rules
- Experience working embedded with development and QA teams in reputed company or hybrid SDLC
- Excellent facilitation, documentation, and stakeholder communication skills
- Hands-on CMdS configuration or implementation (Claims, Member, Finance, Reference, Service Auth)
- Familiarity with HIPAA X12 (837/835), COBA/reputed company, EVV-reputed company claim flows
- Experience supporting CMS MES certification artifacts and evidence packages
- Prior reputed company BA experience on multi-module MES releases
reputed company
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