RATE: Depends on Experience Level II = 7+ years of experience in the role
hybrid work schedule, 2 days a week onsite with occasional 1 hour meetings in person
PRIMARY RESPONSIBILITIES:
• Analysis of current business processes and systems, and documenting requirements for new processes and systems
• Work with internal team and customer on business documentation and updates
• Attend meetings with user groups and document meeting minutes, action items, and decisions.
• Assist with user acceptance testing, including defect reporting and follow up. Help with development of test scenarios and acceptance criteria
• Help with developing presentations for internal team or for the customer. Solicit input from others and pull information together to create a professional presentation.
• Work with team to document updates needed for Operations Guide
• Assist with analysis of Medicaid enrollment, provider and claims data, and document requirements, use cases
• Assist with identifying and documenting data anomalies and collaborate with cross functional teams for effective resolution
• Share use cases to data analysts for profiling, review results and infer compliance to Medicaid / CMS processes and guidelines
• Ability to juggle multiple priorities and ensure availability to questions and clarifications from data analysts
• Positive attitude and willingness to jump in and help where needed
REQUIRED QUALIFICATIONS:
• 5+ years of healthcare business analysis experience supporting business initiatives through data analysis, writing business requirements and user acceptance testing of various systems
• 4+ years of experience in working with State Medicaid and CHIP agencies
• Basic understanding of CMS reporting requirements for Medicaid
• Basic understanding of FFS, Managed Care claim adjudication processes from enrollment to funding/finance
• Basic understanding of managed care encounters
• Knowledge of health insurance, HMO and managed care principles including Medicaid and Medicare regulation
• Knowledge of Affordable Care Act and eligibility
• Be a self-starter and able to thrive in an environment with little guidance
• Strong time management and organizational skills
• Excellent interpersonal, oral, and written communication skills
• Experience with facilitating meetings
• Proficient with MS Word, MS Excel
• Effective organizational, analytical, time management, problem-solving, and multi-tasking skills, and habits; ability to complete assignments under tight deadlines with little/no direct supervision
• Bachelor's degree in related field
PREFERRED QUALIFICATIONS:
• Experience working with PERM, T-MSIS, CMS Federal Reporting or similar projects
• Experience in HEDIS, CHIPRA or similar quality metrics
• Knowledge of Quality of Care program
• Ability to perform some data analysis using SQL, Excel against data warehouses utilizing large datasets
• Knowledge of data integration, software enhancements/planning and agile methodologies
• Experience with using Azure DevOps, SharePoint, MS Project, Visio