We are looking for Medicaid Business Analyst
Job Title: Medicaid Business Analyst
Job Location: Columbia, SC
Job Type: Contract
US citizens and those authorized to work in the US are encouraged to apply. We are unable to sponsor H1b candidates at this time.
SCOPE OF THE PROJECT:
The Replacement Medicaid Management Information System (MMIS) project is one of the largest IT projects for the client.
It is a multi-year effort to replace the States aging MMIS, eligibility system, and related applications with a modern, service-oriented architecture-based system.
This project will be very complex and will demand exceptionally high-quality team members.DAILY DUTIES / RESPONSIBILITIES:
The Provider Services Business Analyst (BA) is responsible for evaluating agency needs, as-is and to-be business processes, and technical designs to provide analysis and advice on strategies for information technology solutions and non-technical solutions. Most of the system development work will be outsourced to vendors and other State organizations.Duties include:
Requirements development execution, including the elicitation, analysis, specification and validation;
Modeling Provider enrollment and payment business processes (As-Is and To-Be) through sequence diagrams, business process models, etc.;
Documenting and analyzing agency business processes and recommending improvements;
Documenting and analyzing provider enrollment and financial requirements and relationships;
Participate in the requirements management processes, including change control; version control; tracking and status reporting; and traceability;
Providing requirement interpretation and guidance to technical and test teams;
Proactively identifying risks, issues, and action items leading to possible solutions;
Interacting with internal and external organizations (i.e. vendors, State and Federal government agencies, State providers and beneficiaries, and other stakeholders).
Planning for, conducting, and reporting on testing and other quality assurance activities;
Other related activities.Subject matter requirements include:
Medicaid or Medicare provider enrollment and management;
Claims processing and payment;
State budget assignments;
Provider reimbursement methodologyREQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE):
Desired 6 years of experience in Provider Enrollment and Management, Claims Payment and Financial systems, but manager would look at someone with less. The more the better
4 years of experience with Medicaid budget assignments and financial general ledger reporting
3 years of experience in healthcare insurance business operations (payer or provider side; government or commercial side) with a focus on provider enrollment and provider reimbursement
3 years of experience in Financial ManagementPREFERRED SKILLS (RANK IN ORDER OF IMPORTANCE):
Understanding of the Medicaid Information Technology Architecture (MITA)
Provider outreach and education
Agile project methodologyREQUIRED EDUCATION:
Medicaid Business Analyst