Request ID: IN-8046-1 (98890523)
EDI QA Lead with BA, 270/271, 276/277, 837, ICD/CPT/HCPCS and MMIS Experience
Location: Columbia SC
Duration: 12 Months
Remote Work Availability: 25%
REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE):
• 10 years’ experience in healthcare insurance; medical review, program integrity, or appeals.
• 5 years’ experience working with IT developers/programmers in payer environment.
• Knowledge of ICD/CPT/HCPCS coding.
• Ability to effectively communicate to executive management, line management, project management, and team members.
PREFERRED SKILLS (RANK IN ORDER OF IMPORTANCE):
• Claims processing systems experience.
• Knowledge of Microsoft Office (Word, Excel, PowerPoint) or other applicable software programs.
OBJECTIVES TO BE FULFILLED BY CANDIDATE:
The principal duties of this position are to coordinate and assist in all areas of UA testing environment for purposes of R-MMIS.
Specific duties include, but are not limited to:
• Ensures the UA testing team completes assignments as expected. Carries out procedures to ensure that all results meet R-MMIS documentation requirements.
• Provides technical assistance as needed in the UA environment.
• Provides quality assurance and analytical support and coordination in testing efforts.
• Provides independent system maintenance support by identifying, validating, analyzing and defining problems/issues. Assists in verification of business process documentation highlighting areas which require updating and working with appropriate staff to provide results in a timely manner.
• Consults with UA testers insuring their understanding of policies/procedures and system functionality design.
• Assist other business analyst with:
– Projects involving enhancement of MMIS.
– Computer program design, coding, testing, debugging, and modifications as required to maintain assigned systems and generate reports and/or data as needed.
• Other duties as assigned.
Desktop/PC Support • Ability to diagnose and troubleshoot computer and network problems Yes 2 Advanced Within 2 Years 1 – 2 Years
Education Medicaid Management Information System (MMIS) experience Yes 1 Advanced Within 2 Years 6 + Years
Specialties EDI Transaction sets (270/271, 276/277, 837) Yes 3 Advanced Within 2 Years 6 + Years