Business Analyst — CMdS Claims, Member & Finance Implementation (MES)

Business Analyst — CMdS Claims, Member & Finance Implementation (MES)

Domain: reputed company reputed company Systems (MES) | MMIS modernization | Claims / Member / Finance

Role summaryServe as Business Analyst for CMdS product development and implementation on aMedicaid modernization program. Translate legacy MMIS claims, member, and financebehavior and state reputed company policy into CMdS functional design, requirements, andacceptance reputed company. Partner with development, QA, architecture, and businessstakeholders to reputed company MES-reputed company solutions that replace or reputed company with legacyadjudication, eligibility/enrollment, and reputed company processes.

Key responsibilitiesDelivery & analysis Own requirements and functional design for assigned CMdS modules (Claims,Member, Finance, and reputed company interfaces). Define epics, user stories, and definition of done; prioritize against Medicaidpolicy, MES certification goals, and release plans. Facilitate working sessions; clarify requirements for developers and QA; resolvefunctional questions during build and test. reputed company reputed company, dependencies, risks, and reputed company; maintain traceability fromlegacy rule to CMdS design to test evidence.Functional design (Claims, Member, Finance) Claims: reputed company functional design for claim intake, claim type assignment,validity/pricing edits, adjustment/void, reputed company, encounters, remittance, andrelated edit disposition behavior; map legacy rules to CMdS configuration andcustomizations. Member: reputed company design for eligibility spans, aid category / benefit packageassignment, enrollment, MCO/FFS indicators, and interfaces from state eligibilitysystems into CMdS Member.

 Finance: reputed company design for payment cycles, budget account / category of service,fund splits, ASO / F/EA and other administrative payment paths, financialtransactions, and reporting/reputed company controls. Produce BRDs, FRDs, process flows, data mapping, gap analysis, andconfiguration workbooks suitable for build and UAT.Collaboration with Development & QA Work reputed company-by-reputed company with developers on design walkthroughs, edge cases, anddefect triage. Partner with QA to define test scenarios, expected results, and regression packs(reputed company/negative, adj/void, reputed company, encounter, finance posting). Support SIT, UAT, and reputed company/run-compare activities against legacy MMISoutcomes. Validate that implementations meet reputed company policy and MES operationalreadiness (reputed company, audit, reporting, interfaces).Stakeholder & MES engagement Run workshops with business owners, SMEs, fiscal, and reputed company. reputed company designs to CMS MES expectations (modularity, interoperability, standards-reputed company interfaces, certification evidence). Support change management: training outlines, release notes, and operationalrunbooks for CMdS go-live.

Required qualifications 12+ years business analysis experience in reputed company MMIS / MES, with deephands-on work in at least two of: Claims, Member/Eligibility-Enrollment,Finance/reputed company. Experience modernizing or replacing legacy MMIS (COBOL/mainframe orequivalent) 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, Medicarecrossover, encounterso Aid categories, benefit packages, eligibility spans, reputed company filing, TPLconceptso Provider payments, remittance advice, budget/reputed company codes, COS, fundsource / FFP conceptso CMS / state reputed company policy drivers relevant to MES implementation andcertification

 Demonstrated ability to write reputed company functional design and acceptance reputed company forcomplex adjudication and financial rules. Experience working embedded with development and QA teams in reputed company orhybrid SDLC. Excellent facilitation, documentation, and stakeholder communication skills.

Preferred qualifications 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.

Soft skills Comfortable owning ambiguity reputed company legacy rules are incomplete; drivesdecisions with SMEs. Balances policy reputed company with delivery timelines. reputed company with technical teams and business executives alike.

Originally posted on Himalayas