Sr Business Analyst

• Exercises significant independent judgment within broadly defined policies and practices to determine best method for accomplishing work and achieving objectives.

• Qualifications
• Bachelors degree or equivalent combination of education and experience.
• Nine or more years of business analysis experience.
• Openly and actively communicates information and takes initiative to communicate extensively.
• Six 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).

Other Qualifications

• Interpersonal skills to interact with customers and team members.
• Regular and reliable attendance is an essential function of the position.
• Handles difficult situations diplomatically.
• Good written and verbal communication skills to ensure clarity.
• Good analytical and problem-solving skills.
• Highly proficient in the use of Microsoft Office Products (PowerPoint, Excel, Word. Visio, Outlook).
• Presentation skills to present to management and customers.
• Ability to work as a team and independently.
• Adaptable to changing priorities.
• Ability to manage multiple priorities ensuring deadlines are achieved.
• Team and goal orientated.
• Ability to work in a remote environment and be self-directed with minimal supervision.