TPL Senior Business Analyst
About The Position
NTT DATA is currently seeking a TPL Senior Business Analyst to join their team. This role requires deep expertise in Medicaid Third Party Liability (TPL), claims processing, and recovery operations. The ideal candidate will have hands-on and in-depth experience and knowledge with Medicaid Management Information System (MMIS), Coordination of Benefits (COB), Crossovers – (Medicare A & B), Medicare Advantage C plans (MCA), and post-payment recovery workflows. The TPL SR BA will support Business Operations Support (BOS) for a state Medicaid Program. Working under the direction of the Operations Manager, the analyst will collaborate with state business staff, system and service vendors, and NTT DATA project managers and consultants to support planning, design, User Acceptance Testing (UAT), implementation, and evaluation of key system and processes changes.
Requirements
- Minimum 10 years of experience supporting large, complex Medicaid system implementation projects and/or Medicaid business operations
- Minimum 8 years of experience with TPL to include a combination of the following: Coordination of Benefits, Medicare Crossover Part (A&B) Claims processing, Medicare Advantage (Part C), claims workflows, including complex claim scenarios and regulatory compliance.
- Minimum 6 years of experience with elicitation and verification of business and technical requirements
- Minimum 3 years of experience with system development methodology and project management principles
- Minimum 3 years of experience conducting reviews of system development life cycle documentation, project and technical architecture and design deliverables/artifacts
- Undergraduate degree or 4 years relevant experience
Nice To Haves
- Candidate must be local to the client in Little Rock, Arkansas
- Experience translating Federal and State regulations into working requirements that are actionable by technical teams
- Experience working with Medicaid Enterprise Systems (MES) vendors
- Ability to translate between non-technical business users and technical IT resources
- Strong SQL and data analysis skills
- Strong understanding of HIPAA and X12 EDI standards
Responsibilities
- Analyze Medicaid claims, TPL workflows, Medicare Crossovers (Pt A&B), Medicare Advantage (Pt C), and recovery data to identify trends, root causes, and opportunities for cost avoidance and recovery optimization
- Translate federal/state TPL policies into system requirements
- Support MMIS enhancements, including adjudication rules and edits, reporting, letters, etc.
- Work with vendors and state stakeholders to improve all faucets of insurance discovery and recovery processes
- Lead requirements gathering, documentation, create and conduct UAT testing
- Identify and report issues, risks, and dependencies
- Support issue triage, backlog management, and operational reporting for day-to-day TPL activities
Benefits
- medical, dental, and vision insurance with an employer contribution
- flexible spending or health savings account
- life and AD&D insurance
- short and long term disability coverage
- paid time off
- employee assistance
- participation in a 401k program with company match
- additional voluntary or legally-required benefits
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
Associate degree
