Business Analyst-Medicaid

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Business Analyst-Medicaid

Remote Job |   2023-02-25 14:24:27

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Job Code : StateOfIL002

Hello,

Hope you are doing good,

Position: Business Analyst

Location: Remote

Duration: Long Term

Client: State of Illinois

Business Analyst (BA) Duties:

• Assist with conducting requirements analysis by reviewing requirements documentation to determine accuracy of the intended MMIS solution. Assist with develop system change requests. Conduct and participate in user acceptance testing test case/script development and test execution. Document defects in quality assurance testing tool. Attend and actively participate in project team meetings. Assist with preparing and submitting weekly status reports.

Business Analyst Skill Requirement

• Bachelor’s Degree in Computer Science, Computer Engineering, Information Technology, or equivalent workplace experience equivalent to four (4) years of college. 5 years business analyst experience. Experience using Microsoft Office tools Word, Excel, PowerPoint. Experience of at least one programming/ scripting language (e.g., Java, SQL). Experience developing SQL queries for analytical purposes. Experience of at least one database management system (e.g., SQL Server, Oracle SQL). Experience of HIPAA X12 transactions relevant to health care operations. Experience using Microsoft Office tools Word, Excel, PowerPoint. Proficiency in written and spoken English.

Individual position subject matter experts include but is not limited to following:

Claims Processing BA skill requirement

• 3 years’ experience with healthcare medical claims processing, including, but not limited to, adjudication, submission, and editing. Experience with billing procedural and diagnosis coding, preferably Medicaid relevant experience. Experience of universal medical codes (HCPCS) for treatment and medical services provided by medical providers. Experience of code set (ICD-10) medical providers use to identify disease, symptoms, etc. Experience with and working knowledge of HIPAA electronic claim transactions (837I, 837P, 837D). Experience with and working knowledge of HIPAA claim payment transaction (835). Experience with and working knowledge of HIPAA claim status transactions (276, 277).

Member Management BA skill requirement

• Experience with Medicaid member eligibility including Medicaid and benefit plan rules management, managed care enrollment and contract management. Experience of HIPAA electronic eligibility, benefit enrollment, and capitation payment transactions (270, 271, 834, 820).

Financial Management BA skill requirement

• Experience with healthcare financial payment management process including remittance advices to billing providers. Experience of HIPAA electronic claim payment transaction (835). Knowledge of Generally Accepted Accounting Principles (GAAP) desired. Experience of Federal Financial Participation (FFP) rules and regulation. Experience developing federal reporting to support FFP reimbursement process.

Collections/Recovery BA skill requirement

• Experience with coordination of benefits for financial recovery of healthcare claim payments. Knowledge of third-party claim subrogation and member estate/lien processes.

Provider Management BA skill requirement

• Experience with the enrollment and management of healthcare providers.

Pharmacy Claims BA skill requirement

• Experience with point-of-sale pharmacy claims processing, including, but not limited to, adjudication, submission, and editing. Experience of pharmacy billing code standards (NCPDP), preferably Medicaid relevant experience. Experience with NCPDP electronic claim transactions.