Job Details

Senior Business Analyst - Claims (831) (02/04/2016)

Salt Lake City, UT

  • Review existing documentation
  • Conduct requirements management activities
  • Create/update/maintain requirements specification documents, general system design documents and detailed system design documents
  • Work with the technical lead assigned to the business area, defines design solution across all system components, and identifies all configurations and builds task
  • Reviews and comments on "As Is" and "To Be" business process work flows
  • Act as a Medicaid subject matter expert (SME)
  • Communicate status, issues and risk to management team
  • Participates in collaborative sessions to document Medicaid business processes
  • Provides requirements statements and business rules to articulate end-user functionality
  • Ensure all business area requirements are included in the overall requirements documentation and design documentation
  • Communications (oral, electronic) with State Representatives when directed
  • Participates in testing, acceptance testing and implementation of information systems, modules and subsystems
  • Participates in systems development efforts
  • Provides user support during application software implementations
  • Participates in training users on application software
  • Other duties as assigned

Required Skill

Primary Skills

  • Bachelor's degree from a four-year accredited college or university
  • Five (5) years experience as a business analyst for a Medicare or Medicaid or Health care entity.
  • Extensive knowledge of healthcare claims processing, including FFS, Encounters, edits and adjustments
  • Knowledge of claims pricing methodologies across multiple claim types
  • Knowledge of CPT, HCPCS, ICD-9, ICD-10, DRG, Rev Code, coding methodologies
  • Knowledge of claim form rules for UB, CMS and ADA
  • Knowledge of HIPAA Claims Transactions 837I/P/D
  • Three (3) years full-time experience as a business analyst, systems analyst, programmer analyst or programmer (experience in multiple roles listed may be combined to meet requirement).
  • Proven ability to produce high quality system documentation (including system overviews, business use cases and end to end flow diagrams)
  • Excellent analytical and problem solving skills
  • Self-motivated and demonstrated leadership abilities
  • Excellent customer relation skills, including presentation and meeting facilitation
  • Strong attention to detail
  • Excellent written and verbal communication skills with ability to communicate technical issues to nontechnical and technical audiences
  • Ability to multitask in a dynamic project environment
  • Proficient with MS OFFICE

Secondary Skills

  • Familiarity with the ICD10, Affordable Care Act
  • Familiarity with HIPAA and NCPDP standards
  • Previous experience in a DDI effort
  • PMP Certification
  • MITA business process areas
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