Role: Healthcare Business Analyst
Location: Richmond, VA –Remote till covid-19
· 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.
· 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