Business Analyst - Claims

Hybrid Details: One day per month onsite, last Wednesday of the month
Duration: 6 months to start
Project Summary:

• The client is seeking to hire a Business Analyst- Claims expertise to join our collaborative Medicaid Management Information System (MMIS) team.
• The Business Analyst (BA) will work on our established Provider Reimbursement and Claims processing functional areas to support the development, testing and implementation of projects and enhancements to meet the business objectives of the MassHealth (Massachusetts Medicaid) program specifically projects to support the member community. BA should be well versed in health plan management, operational concepts, and the systems development lifecycle.
• Preference will be given to candidates with Medicaid systems experience well as claims and business knowledge of the MassHealth program.
• The BA must have sufficient knowledge of the entire scope of the health care business systems and excellent knowledge in the Claims Processing area to ensure that the development and testing work within their functional area is compatible with the MMIS system.
• The BA’s primary responsibility is to ensure that the implemented coding scheme meets the requirements of the business community and conforms to all applicable Federal and state laws. The BA will be called upon to act as an active member in all phases of the project including gap analysis, requirements gathering, design and development activities, documentation, testing, implementation, and stabilization.
• The BA will be expected to work independently, as part of a team as well as with business stakeholders so excellent communication and documentation skills is a requirement for this job. Knowledge of Pharmacy Claims processing, Interoperability and/or X.12 emerging standards is beneficial.

Responsibilities:

• Lead and participate in joint application design session with stakeholders
• Knowledge of SDLC and Agile methodology a plus
• Develop test strategies, test scenarios and test cases based on written requirements
• Execute and review test runs and sign off on testing components
• Document requirements and participate in their development and testing
• Support the development of end-user training materials and end-user documentation as required.
• Possible oversight role during the stabilization phase of each release including the monitoring of system change execution, the development of system “fix” strategies and the close monitoring of the implementation of those strategies
• Work with vendors to ensure business requirements are fully defined and tested.
• Communicate updates and changes to impacted stakeholders
• Represent MMIS in business meetings as needed
• Support program staff, vendors, and other stakeholder with MMIS related questions or concerns.
• Provide back up to other business analysts as needed.
• Data query and analysis.

Preferred Qualifications:

• Proficient in business analysis to support all stages of system project lifecycle
• Competency in HIPAA claims and payment transaction processing
• Strong data analysis skills- SQL proficient
• Excellent communication and documentation skill
• Excellent interpersonal skills necessary to interact effectively with project managers, developers, business analysts, systems analysts, SQA analysts, business users/stakeholders, and data processing personnel; as well as interact with representatives from external agencies and companies.
• Demonstrated ability to work independently, as well as within project teams, providing relevant system analysis services.
• Highly analytical, with the ability to independently analyze, document findings and recommend solutions.

Education and Certifications:

• Bachelor’s degree or higher in Business, IT or Healthcare administration with minimum 3 years’ experience, or equivalent in healthcare administration setting

Talent Groups is an equal opportunity employer that values diversity and inclusion. All qualified applicants will receive consideration without regard to protected characteristics. The listed compensation range represents a good-faith estimate and may vary based on experience, skills, education, certifications, market conditions, client budget, and location, in accordance with applicable pay transparency laws.