Job ID: NC698264 (96591209)
Remote Pharmacy BA with Claims, SQL, EDI, X12, NCPDP, HL7, HIPAA PHI, ICD-10, Agile, QA, and Medicaid experience
Location: Raleigh NC (DHHS)
Duration: 12 months
Positions: 1 (1/2)
NC Dept of Health and Human Services (DHHS) is seeking a Senior Pharmacy BA Lead to perform Business Analysis work related to support the Managed Care Transition and MES Projects.
SkillRequired / DesiredAmountof Experience
Experience with Healthcare Pharmacy Claims ProcessingRequired3Years
Experience in the review, analysis and reporting of test results.Required5Years
Experience on testing web applicationsRequired5Years
Excellent verbal and written communication skills with the ability present to both technical and business audiences.Desired
Proven experience developing SQL queries.Required2Years
Knowledge of Agile MethodologyRequired3Years
Experience in working with the Business Teams to write Business and QA Documents .Required3Years
Experience in validating all pharmacy interfaces/filesRequired3Years
This position is responsible for the following activities :
•Demonstrated knowledge in creating test scenarios/cases in consultation with the business owners, hands-on testing, test results review, and proactively identifying issues and providing resolutions/recommendations
•Proven knowledge in Medicaid or similar claims ( pharmacy) processing systems
•Extensive knowledge of pharmacy claims and business policies
•Thorough knowledge of system functional areas such as recipient, provider, prior authorization, reference, program integrity, financial and claims
•Thorough knowledge of Federal and State regulations, statutes, and rules
•Knowledge base/experience with encounter claims and be ready to lead any work effort pertaining to encounter claims
•Expert knowledge on SQL, EDI, X12, NCPDP, HL7, HIPAA PHI, ICD-10
•Clear understanding of the deliverables process, e.g. System Documentation release,
•Working knowledge of defect process
•Proven experience with the system development life cycle (SDLC)
•Experience working on large Federal/State contracts
•Proficient with Microsoft Word, Excel, Visio, Project, OneNote, Outlook, and PowerPoint