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Business Analyst with US Healthcare, Medicaid, Claims, QNxt or Facets
2 months ago
As a Business Analyst with US Healthcare, Medicaid, Claims, QNxt or Facets 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 community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position.
Your role in our missionMake your mark as Gainwell develops innovative, purpose-built technologies and solutions to deliver better health and human services outcomes.
- Support the full life cycle of development activities to assist us in delivering new services and technical products to clients
- Perform as an advisor and individual contributor for product systems, processes, software configuration, network architecture and interface capabilities
- Assist in preparing and addressing product requirements by determining usability and implementing change requests to meet business needs
- Deploy specific product configurations and bring your skills to overall system design and integration
- Participate in user acceptance testing and coordinate product launches into new and existing markets
- Get involved in helping define and outline business cases to ensure that our proposed solutions can deliver significant business benefits to clients
Qualifications
- Bachelor's degree or equivalent combination of education and experience.
- 4 or more years of business analysis experience.
- Openly and actively communicates information and takes initiative to communicate extensively.
- 3 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).
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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