Business Analyst - Manufacturing

HEXAWARE•United States,

18h•Remote

About The Position

We are seeking a Senior Business Analyst with expertise in the Claims module to play the role of Claims Domain lead for MMIS health care projects. In this remote role, you will drive the claims module and process, leveraging your domain knowledge to analyze business requirements, design and develop documentation, and ensure quality processes. You will coordinate with customers, work in a team environment, and provide guidance throughout the entire project lifecycle. Your responsibilities will include meeting customer expectations, troubleshooting application issues, and assisting customers with implementation decisions.

Requirements

Strong experience/ knowledge of Claims Process - How claims are processed and how pricing is done in Medicaid Field.
Strong health care domain experience.
Good knowledge of Medicaid and Medicare.
Hands-on experience in claims processing and Adjudication processes.
Good experience in Reference code/data sets required in Claims adjudication.
Prior experience or understanding in configuring benefits or programs in claims system across various sub-systems.
Excellent written and spoken communication skills.
Ability to multitask between internal team and clients based on priority tasks.
In depth understanding of Claims and Claims lifecycle: Member, Provider, Claim submission – Paper and EDI X12, Adjudication, Payment Cycle (Finance), Reporting.
Knowledge of Claim Types: Professional, Dental, Institutional, Pharmacy, Encounters and Capitation.
Knowledge of Claim Formats: EDI X12 formats like 837P/I/D, X12 formats 835, 834, 270/271, 276/277.
Familiarity with systems like CMdS, GHS, Facets and etc.

Responsibilities

Play the role of Claims Domain lead for MMIS health care projects.
Drive the claims module and process, and domain knowledge.
Perform analysis of business requirements.
Design and develop documentation.
Ensure quality process.
Coordinate with customers.
Work in a team environment and provide guidance throughout the entire life cycle.
Responsible for meeting customer expectations.
Troubleshoot problems in the application.
Assist customers in implementation decisions.
Run queries and perform basic system analysis, RCA etc.
Work closely with the client and development team during the stages of development.
Conduct demos at completion of milestone, track and close feedback from such demos.
Work closely with Dev, architecture, and Design teams to define the GUI view and platform requirements, which is the foundation of the product.