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Gainwell Technologies

Compare

4.1

based on 96 Reviews

3 Gainwell Technologies Business Analyst Jobs

Business Analyst (US Healthcare / Medicaid)

Gainwell Technologies

4.1

based on 96 Reviews

0-2 years

Bangalore / Bengaluru

1 vacancy

Business Analyst (US Healthcare / Medicaid)

Gainwell Technologies

posted 1mon ago

Job Role Insights

Flexible timing

Key skills for the job

Data Analysis Healthcare Information Technology US Healthcare Claims Adjudication IT Business Analysis

+ 3 more

Job Description

Analyzes client requests for proposals and applies advanced subject matter knowledge to solve complex business issues and is regarded as a subject matter expert.

Adheres to and supports Configuration team approach and other configuration principles, methodologies, and practices.
Ensures communication among all key stakeholders.
Exercises significant independent judgment within broadly defined policies and practices to determine best method for accomplishing work and achieving objectives.
May provide mentoring and guidance to lower-level employees.
Works closely with the implementation team to analyze and document clients business requirements and processes. Communicates these requirements by constructing configuration deliverables.
Creates test cases from functional requirements, executing test cases, and documenting results.
Participates in technical reviews and inspections to verify intent of change is carried out through the entire project.
Assists in coordinating business analyst tasks on information technology projects and provide support to other team members.
Provide accurate status and time reporting for project related tasks.
Medicaid Systems work experience.
Ability to exercise discretion and independent judgment.
Analyzes configuration data and structure to isolate defects.
Research and define solutions for new configuration, legislation, or client rules.
Creates proof of concept testing for new business processes or outcome requests.
Creates and presents solution, proof of concept, or testing results to customer.
Completes configuration within schedule timelines and configuration best practices.

What were looking for

Qualifications

Bachelors degree or equivalent combination of education and experience.
Three or more years of business analysis experience.
Openly and actively communicates information and takes initiative to communicate extensively.
Three or more years experience configuring in QNXT or FACETS:
Contracts/benefits.
System data points needed for successful X12 transactions, Claim Adjustment Reason Codes and Remittance Advice Code.
Contracts for provider services, benefits for member coverage, fee schedules, capitation, and claim editing enforcement.
Understands Medicaid Program structure in carriers, programs, benefit plans, policy, policy plans, sponsor, and or policies.
Understands Provider (Contract and Pricing) data including but not limited to provider type, specialty, taxonomy, enrolment impacts, service locations, certifications and licensing, affiliations, and reimbursement impacts.
Understands Member data including but not limited to aid categories, coverage codes, benefit packages, restrictions, limitations, prior authorizations, programs, and primary care providers.
Experience with Configuration Implementation Build & Maintenance.
Experience working with complex systems at a detailed level.
Experience working in a virtual team environment performing self-directed tasks.
Understands relational database concepts and schemas.
Experience writing SQL queries for data analysis.
Experience working with Medicaid/MMIS systems.
Preferred experience includes DDI (Design, Development, and Implementation) and operations phases.
Experience processing Medicaid claims and ability to troubleshoot adjudication results.
Demonstrated aptitude for learning new technologies and keeping current with industry best practices.
Experience with Requirement Traceability Matrices.
Ability to multi-task and maintain organization in a fast-paced environment.
Ability to create and maintain highest levels of confidentiality when dealing with proprietary or private information.
Ability to exercise sound judgment and make decisions in a manner consistent with the essential job function.
Preferred experience working with HP Application Lifecycle Management (ALM).