Location: Columbia, SC
Duration: 12+
Interview mode: Phone then Skype
SCOPE OF THE PROJECT:
This project will be very complex and will demand exceptionally high quality team members
DAILY DUTIES / RESPONSIBILITIES:
A Replacement MMIS Business Analyst (BA) is responsible for evaluating agency needs, as-is and to-be business processes,
and technical designs to provide analysis and advice on strategies for information technology solutions and non-technical solutions.
Duties include:
• Requirements development execution, including the elicitation, analysis, specification and validation.
• Documenting and analyzing agency business processes and data. Recommending improvements, data requirements and relationships.
• Participate in the requirements management processes, including change control; version control; tracking and status reporting; and traceability.
• Providing requirement interpretation and guidance to technical and test teams.
• Proactively identifying risks, issues, and action items leading to possible solutions.
• Interacting with internal and external organizations (i.e. vendors, State and Federal government agencies, State providers and beneficiaries, and other stakeholders).
• Planning for, conducting, and reporting on testing and other quality assurance activities.
• Other related activities.
Subject matter areas include: provider management, member (beneficiary) management/eligibility, claims (professional, institutional, pharmacy, dental, durable medical equipment, transportation, etc.),
third party liability, claims payment, and State budget assignments, financial management, provider reimbursement methodology,
drug rebate, prior authorization, managed care, behavioral health, long-term care, program integrity, electronic health records,
benefit plan administration, etc.
Familiarity with X12 EDI transactions, and the Affordable Care Act and it impacts on Medicaid eligibility and health insurance exchanges is also beneficial.
EXPERIENCE REQUIRED:
Claims Payment and Financial systems
• Medicaid budget assignments and financial general ledger reporting
• Strong background and at least 6 years' experience in healthcare insurance business operations.
• At least 4 years experience in healthcare insurance IT software/systems implementations
• Ability to properly document business requirements.
• Ability to interpret business process and business data models.
• Vendor management experience –
• Superb written and oral communications skills, including the ability to give presentations to executive management.
Strong proficiency in English is required.
• Impeccable integrity. This project will have very high visibility and will impact significant expenditures of public funds.
Candidates must be confident with their abilities to make correct decisions and the courage to speak out when necessary.
• Willingness and ability to effectively engage with people and organizations on a continuous basis.
• Agile, waterfall, SDLC, PLC
• Requirements gathering experience
PREFERRED SKILLS (RANK IN ORDER OF IMPORTANCE):
• Medicaid Information Technology Architecture (MITA).
• Medicaid Enterprise Certification Toolkit (MECT).
• outsourced healthcare insurance operations environment.
• outsourced IT development project.
• creating business process and business data models.
• Public sector procurement experience is a plus.
REQUIRED EDUCATION:
Bachelor's degree.
Regards
Swami A
Technical Recruiter
Ennovace Inc
Ph: 214-541-9378
F: 972-913-8300
1801 S O'connor Rd
Irving TX 75061
In my absence please contact Steven at steven@ennovace.com (214-541-9081)
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Thank you
Regards
Swami A
Sr. Marketer
Ennovace Inc
Ph: 214.541.9378
F: 724.264.5637
www.ennovace.com
1801 S O'connor Rd
Irving TX 75061
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