What are the responsibilities and job description for the Senior Business Analyst with Claims - Remote with Travel position at The Dignify Solutions, LLC?
1. Candidate should have strong health care domain experience and should have good knowledge of Medicaid and Medicare.
- 2. Candidate should have hands-on experience on claims processing and Adjudication processes.
- 3. Must have good experience in Reference code/data sets required in Claims adjudication.
- 4. Must have prior experience or understanding in configuring benefits or programs in claims system across various sub-systems.
- 5. Should be able to run queries and perform basic system analysis, RCA etc.,
- 6. 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
- 7. Must have excellent written and spoken communication skills. Should be able to multitask between internal team and clients based on priority tasks
- 8. Work Closely with Dev, architecture and Design teams to define the GUI view and platform requirements, which is the foundation of the product.
- 9. In depth understanding of Claims and Claims lifecycle:
- Member
- Provider
- Claim submission - Paper and EDI X12
- Adjudication
- Payment Cycle (Finance)
- Reporting
- 10. Claim Types:
- Professional
- Dental
- Institutional
- Pharmacy
- Encounters and Capitation
- 11. Claim Formats:
- EDI X12 formats like 837P/I/D
- X12 formats 835, 834, 270/271, 276/277
- 12. Claim System:
- Familiarity with systems like CMdS, GHS, Facets and etc
- Technical Skills
- SQL: To validate data in backend tables (e.g., claim status, payment details, find members/providers, Benefit Plan).
- EDI Tools: Validating X12 files.
- Interface Testing: Understanding how data flows between systems and formats and use tools like postman
- Preferred skills:
- Minimum of 8 years of experience in health care experience especially in MMIS domain.
- Capability to think out-of-the-box to create new solutions as needed.
- 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 stake holders 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.
- Communication: Collaborate with cross-functional teams