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Technical Business Analyst
Location
United States
Posted
4 days ago
Salary
$50 - $120 / hour
Seniority
Lead
Job Description
Technical Business Analyst
OmegaHires
• Must have very good understanding of the healthcare payer space with a minimum experience of 10 years in the domain. • Must have a prior experience in implementing/maintenance of commercial payer claims solution and/or Medicare/Medicaid system. • Must have good experience with claims processing concepts, along with the provider, member enrolment and care management concepts. • Must have good experience in Reference code/data sets required in Claims adjudication including not limited to CPT, CDT, HCPCS, ICDs. • Must have prior experience or understanding in configuring benefits or programs in claims systems across various sub-systems. • Must be able to work with the clients to create/gather requirements and document them according to standards. • Must adhere to (or if needed, define) the processes for requirement solicitation, documentation and hand off. • Should work closely with the IT development team to elucidate the requirements, enable constructive discussions / brainstorming sessions to implement the best in class solution. • Should have basic understanding concepts like web services, relational databases etc. • Should be able to run queries and perform basic system analysis, RCA etc. • Should be able to create mapping documents for the various interfaces and include business rules, transformation and DB mapping. • Should work closely with the client and development team during the stages of development, and conduct demos at completion of milestone, track and close feedback from such demos. • Must have excellent written and spoken communication skills. Should be able to multitask between internal team and clients based on priority tasks. • Work Closely with Dev, architecture and Design teams to define the GUI view and platform requirements, which is the foundation of the product.
Job Requirements
- Must have very good understanding of the healthcare payer space with a minimum experience of 10 years in the domain.
- Must have a prior experience in implementing/maintenance of commercial payer claims solution and/or Medicare/Medicaid system
- Must have good experience with claims processing concepts, along with the provider, member enrolment and care management concepts.
- Must have good experience in Reference code/data sets required in Claims adjudication including not limited to CPT, CDT, HCPCS, ICDs.
- Must have prior experience or understanding in configuring benefits or programs in claims systems across various sub-systems.
- Must be able to work with the clients to create/gather requirements and document them according to standards.
- Must adhere to (or if needed, define) the processes for requirement solicitation, documentation and hand off.
- Should work closely with the IT development team to elucidate the requirements, enable constructive discussions / brainstorming sessions to implement the best in class solution.
- Should have basic understanding concepts like web services, relational databases etc.
- Should be able to run queries and perform basic system analysis, RCA etc.
- Should be able to create mapping documents for the various interfaces and include business rules, transformation and DB mapping.
- Should work closely with the client and development team during the stages of development, and conduct demos at completion of milestone, track and close feedback from such demos
- Must have excellent written and spoken communication skills. Should be able to multitask between internal team and clients based on priority tasks
- Work Closely with Dev, architecture and Design teams to define the GUI view and platform requirements, which is the foundation of the product.
- Capability to think out-of-the-box to create new solutions as needed.
- Prior experience as a IT QA or Developer in a healthcare system would be helpful though not mandatory.
- Ability to validate Test scenarios and test plans, test data.
- Should be able to Review requirements, documentation and create Requirements Traceability matrix (RTM)
- Should have excellent communication (written and spoken ) skills to engage with different stakeholders like QA/dev team, clients, end users of Clients and Business Units.
- Ability to assess current functionality available in a product vis a vis market trends, regulatory requirements to be implemented in future version of the product.
- Ability to drive and share the requirements with Technical and Architects regarding product features to be implemented.
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