Job Description

12+ years of Business Analysis experience with strong Medicaid MMIS/MES domain expertise.
Hands-on experience with Health Enterprise, QNXT, Facets, or similar Medicaid claims platforms.
Strong experience in at least 2 of 3 areas: Claims, Member/Eligibility, Finance.
Experience with Medicaid claims processing, adjudication, adjustments/voids, encounters, Medicare crossover, remittance, and payment processing.
Strong knowledge of Medicaid eligibility, enrollment, aid categories, benefit packages, MCO/FFS, TPL, capitation, ASO, and FFP.
Experience modernizing/replacing legacy MMIS/mainframe systems with commercial Medicaid platforms.
Ability to create BRDs, FRDs, user stories, functional designs, process flows, data mappings, and acceptance criteria.
Experience working closely with Development, QA, Architecture, SIT/UAT, and defect triage teams.
Knowledge of HIPAA X12 837/835, COBA/crossover, interfaces, and Medicaid financial accounting.

Business Analyst with Medicaid/MMIS (Claims/Finance/Members) experience- Remote

Quick Overview