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Senior Professional Business Analyst
3 months ago
Summary
As a Senior Professional Business Analyst at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve a communitys most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcares biggest challenges. Here are the details on this position.
Your role in our mission
Play a critical part in ensuring Gainwell is meeting our clients objectives in important areas.
Help coordinate a business analyst teams duties and activities on IT projects and nurture newer team members by providing guidance and support Be a knowledgeable bridge between clients, project managers and technical staff to define, document and share business requirements and expected impact Work with the client to develop business specs at the start of a technical project Analyze, plan, design, document or make recommendations to improve business processes to support clients technology goals Help verify that all requirements have been met by approving and validating test results Exercise your ability to use basic analytical or relational database software such as Excel or SQL to quantify the anticipated impact of work
What we're looking for
Summary
The primary responsibility of a Sr. Business Analyst (QNXT/Facets) is to analyze and document business processes, gather and define requirements, and collaborate with stakeholders to ensure the successful implementation of solutions that meet the unique challenges and requirements of the healthcare industry. The successful candidate will be an intellectually curious, self-directed individual with excellent organizational skills and attention to detail. This role is highly collaborative in nature providing support for IT and business teams. Performs complex analyses of State Medicaid Policies, and Legacy System business rules from data extracts.
Qualifications
Bachelor's degree or equivalent combination of education and experience. Six or more years of business analysis experience. Openly and actively communicates information and takes initiative to communicate extensively. Four or more years experience configuring in QNXT or FACETS: Contracts/benefits. System data points needed for successful X12 transactions, Claim Adjustment Reason Codes and Remittance Advice Code. Contracts for provider services, benefits for member coverage, fee schedules, capitation, and claim editing enforcement. Understands Medicaid Program structure in carriers, programs, benefit plans, policy, policy plans, sponsor, and or policies. Understands Provider (Contract and Pricing) data including but not limited to provider type, specialty, taxonomy, enrolment impacts, service locations, certifications and licensing, affiliations, and reimbursement impacts. Understands Member data including but not limited to aid categories, coverage codes, benefit packages, restrictions, limitations, prior authorizations, programs, and primary care providers. Experience with Configuration Implementation Build & Maintenance. Experience working with complex systems at a detailed level. Experience working in a virtual team environment performing self-directed tasks. Understands relational database concepts and schemas. Experience writing SQL queries for data analysis. Experience working with Medicaid/MMIS systems. Preferred experience includes DDI (Design, Development, and Implementation) and operations phases. Experience processing Medicaid claims and ability to troubleshoot adjudication results. Demonstrated aptitude for learning new technologies and keeping current with industry best practices. Experience with Requirement Traceability Matrices. Ability to multi-task and maintain organization in a fast-paced environment. Ability to create and maintain highest levels of confidentiality when dealing with proprietary or private information. Ability to exercise sound judgment and make decisions in a manner consistent with the essential job function. Preferred experience working with HP Application Lifecycle Management (ALM).
What you should expect in this role
Fast paced, challenging and rewarding work environment. Work life balance. Hybrid Office environment. Will require late evening work to overlap US work hours.
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