Job ID: BL-11452-1 (913591213)
Hybrid/Local Govt Healthcare BA (15+) with PM, MMIS, QA, MS Project Server, claims experience
Location: Columbia, SC
Duration: 12 Months
Remote Work Availability: 25%
Skills:
Administrative Verbal Communication Skills Yes 1 Expert Currently Using 6 + Years
Administrative Written Communication Skills Yes 1 Expert Currently Using 6 + Years
Education Bachelor’s degree in a technical or business field Yes 1 Expert Currently Using 6 + Years
Education Medicaid Management Information System (MMIS) experience No 1 Expert Currently Using 6 + Years
Miscellaneous experience in government IT projects as a business analyst or related duties Yes 1 Expert Currently Using 4 – 6 Years
Miscellaneous graphical process flow software Yes 1 Expert Currently Using 6 + Years
Miscellaneous Customer service skills No 1 Expert Currently Using 6 + Years
Packaged Applications Microsoft Office Suite No 1 Expert Currently Using 6 + Years
Quality Assurance (QA) Claim processing testing experience in the healthcare industry (preferably Medicaid) Yes 1 Expert Currently Using 1 – 2 Years
Quality Assurance (QA) Use Cases Yes 1 Expert Currently Using 6 + Years
Specialties Translating business requirements or policy documentation into test cases and scenarios Yes 1 Expert Currently Using 6 + Years
Specialties Medicaid or healthcare experience No 1 Expert Currently Using 6 + Years
Additional Skills:
An understanding of technological trends to bring solutions to business units supported to enhance the enterprise’s competitive edge (preferred, expert, currently using, 6+years); 2 years of relevant work experience may be substituted for 1 year of education (required, expert, currently using, 6+years)
Description:
Job Description: SCOPE OF THE PROJECT:
Objectives to Be Fulfilled by Candidate:
The principal duties of this position are evaluating agency needs, as-is and to-be business processes, and technical designs providing analysis and advice on strategies for information technology and non-technical solutions. The consultant will provide detailed analysis and document business processes and requirements.
Specific duties include, but are not limited to:
• Serves as a liaison between the business programs community and the IT organization to provide technical solutions to meet user needs.
• Analyzes business operations to understand their strengths and weaknesses to determine opportunities to automate processes and functions.
• Assists in the business process redesign and documentation as needed for new technology.
• Documents and analyzes agency business processes and recommends improvements.
• Proactively identifies risks, issues, and action items leading to possible solutions.
• Researches and maintains business rules, requirements, and models in a repository.
• Review claim submission and documentation for completeness and validity to determine payment/rejection according to member’s plan benefits and department claims processing policies and procedures.
• Demonstrate a knowledge of relevant policies and procedures that impact claims processing decision points. Identify potential conflicts and share information with team and supervisor to eliminate delays and need for additional processing steps.
• Collaborate with other agency employees and external stakeholders, as necessary. Acts with proactive intent to improve claims related outcomes.
• Other project-related duties.
REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE):
• 5 years’ experience in government IT projects as a business analyst or related duties
• Superb written and oral communications skills, including the ability to write requirements and Use Cases.
• 1 year experience in healthcare claims payment operations
• Understanding of business modeling techniques, including the use of graphical process flow software
• Ability to effectively communicate to executive management, line management, project management, and team members.
PREFERRED SKILLS (RANK IN ORDER OF IMPORTANCE):
• General Subject Matter Expertise as it relates to Medicaid or other healthcare insurance experience (project or operations)
• MMIS experience (project or operations)
• Microsoft Office Project/Project Server
• An understanding of technological trends to bring solutions to business units supported to enhance the enterprise’s competitive edge.
• Healthcare Customer Service experience.
REQUIRED EDUCATION:
Bachelor’s degree in a technical, business, or healthcare field or equivalent experience.
2 years of relevant work experience may be substituted for 1 year of education
Professional Reference Check Form.docx