Business Analyst (Claims), Senior

Acentra Health, LLC•UNAVAILABLE, UNAVAILABLE

About The Position

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector. Acentra Health is looking for a Senior Business Analyst (Claims) to join our growing team. Job Summary: Business Analyst, Specialist is responsible for logical design and functional behavior of the solutions involving complex information systems under no supervision for one or more systems including: Provider Enrollment, Claims, and Prior Authorization. This role would review, evaluate, and recommend solution for various business requirements; would provide a fully integrated solution ensuring accomplishment of business requirements; would collaborate with customers and stakeholders and use business modeling techniques to deliver effective “to be” operating models and roadmaps; and work to develop an integrated view of the solution and align project with the strategic business vision.

Requirements

Bachelor’s degree or equivalent experience in lieu of a degree
Minimum 5+ years of business analysis experience in Healthcare Domain knowledge with strong knowledge on Medicare / Medicaid Management Information System around Core Claims and/or Provider Management and Enrollment System experience
Minimum 5 years of experience on large complex project and domain knowledge of Medicare healthcare vertical.
Strong knowledge in Medicare policies and guidelines.
Strong knowledge in claims adjudication and validations.
Strong knowledge in Medicare Reimbursement methodologies.
Excellent Business Analysis Process (SDLC, documentation procedures) experience.
Excellent customer relation skills including presentation and meeting facilitation.
Experience facilitating and running customer facing requirements and design sessions.
Excellent requirements elicitation and validation skill.
Strong knowledge and proficiency in SQL, plus high-level of technical and database knowledge.

Responsibilities

Elicit requirements working with customer and stakeholders.
Demonstrates in-depth knowledge of business and technical solutioning relates to Core Claims to ensure high quality.
Works with customers on presenting technical solutions for complex business functionalities.
Possesses unwavering commitment to customer service and operational excellence.
Provides customer support through leading client demos and presentations.
Prioritizes and schedules work assignments based on the project plan, handling multiple tasks across project phases.
Creates and modifies Business Process Models.
Understands the overall system architecture and cross-functional integration.
Demonstrates in-depth knowledge of business analysis relates to Provider Enrollment, Maintenance and Screening to ensure high quality.
Possesses in-depth knowledge and is well-versed in multiple functions or capabilities.
Uses cases, workflow diagrams, and gap analysis to create and modify requirements documents and design specifications.
Analyzes user requirements and client business needs, leveraging expert opinion and expertise.
Acts as the requirements subject matter expert and supports requirements change management.
Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.