Position Details: Business Analyst

Description:

Role: Healthcare Business Analyst

Location: Richmond, VA –Remote till covid-19

Duration: Contract

  

 

Primary Responsibilities:

·         Healthcare Business Analyst translates business needs into clearly defined and documented detailed, high quality requirements and/or supplemental specifications for new applications or analyzes change requests/enhancements in existing applications.

·         Analyzes data to determine business problems.

·         Handles information including patient services and how the services are paid after conducting investigations and pursuing recoveries through contact with various parties.

·         Works collaboratively within or outside the team to identify charge system weakness, to recommend changes and focused education.

·         Will also ensure adherence to compliance policies and contracts. Knowledge and experience of Medicare & Medicaid.

·         7+ years of experience working in an operations role at a health plan

·         4+ years of Healthcare experience in any of the following:

·         Government Programs,  Core Administer Delivery, Program Management, Product Management, or Network Management

·         2+ years of experience in one or more of the following:

·         Operational business process improvement, business process analysis, benchmark analysis or workflow analysis

·         Ability to work on claims with different LOBs such as Commercial, Medicare, Medicaid etc.

·         Knowledge and experience of Medicare & Medicaid state level reporting levels

·         Strong Knowledge/Experience with Dimensional Modeling

·         Strong understanding of healthcare data formats, standards, and can map them to CMS and state level reporting needs

·         Good understanding on the lifecycle of claims adjudication

·         Possess good exposure on the various claim functionalities such as Edits, COBs, claims adjustments, Episodes etc.  

 

Preferred.

 

·         Experience working with Medicare, Medicaid Blues organization(MCO)

·         Understanding of Medicare Part A,B

·         Understanding of handling claims population for Dual eligible populations

·         Knowledge of Medicare/Medicaid reimbursement methodolog

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