Direct Client Position // Business Aanalyst/Health Care
Hiring:
Business Aanalyst/Health Care
Columbia, SCDirect Client
Job Title:
Business Aanalyst/Health CareLocation:
Columbia, SCDuration: 12 Months
Client: State of SC
Direct Client Position
Descripatyion:
The Business Analyst will work with various internal teams including Program Management/Project Managers, and other SMEs to evaluate Healthy Connections Prime business requirements. Provides technical designs to provide analysis and advice on strategies for information technology solutions and non-technical solutions. The majority of system development work will be outsourced to vendors and/or other state organizations.
We are looking for candidates who are highly organized, can work independently in a fast-paced environment and produce multiple quality deliverables with varying deadlines. Candidates should be self-starters and creative problem solvers and have the flexibility to learn new products and technologies quickly.
ESSENTIAL RESPONSIBILITIES:
Analyze existing legacy code (COBOL, JCL, etc.) and documents existing as-is processes identifying all inputs, system processes, and outputs.
Analyze and document data requirements and relationships.
Document policy requirements and business rules to be carried over as to-be requirements in the form of user stories.
Develop programming specifications to support development team(s).
Work closely with the Enterprise Architect and Technical Manager in obtaining and validating artifacts of legacy system and future enterprise.
Actively participate in project scrum team(s) in assisting with release planning, software development, testing, and implementation.
Proactively identifying risks, issues, and action items leading to possible solutions.
Interact with internal and external organizational teams (i.e. vendors, state and federal government agencies, state providers and beneficiaries, and other stakeholders).
Other related activities as assigned.
Analyze business processes to ensure proper system configuration
Establish a quality management program, from concept to formulation, for a very complex IT and business transformation program;
Develop and maintain the program's Quality Management Plan and Change Management Plan;
Mentor and train the program team on quality principles and assisting them in applying those principles to the project and functional areas under their control;
Subject matter areas include: Provider Management, Member (beneficiary) management/eligibility, Claims editing and pricing (professional, institutional, pharmacy, dental, durable medical equipment, transportation, etc.), Claims Payment and State budget assignment, Financial Management, Provider re-imbursement methodology, third party liability, 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 is also beneficial.
REQUIRED SKILLS/KNOWLEDGE:
Finance experience required on Project planning and financial budgeting
Training and experience in financial analysis and assessment;
Experience in the financial analysis of large health data systems;
Experience in government Medicaid financial reporting;
Experience in state Medicaid MARS/SURS financial analysis and reporting;
Strong background and at least six years experience in healthcare insurance business operations (payer or provider side; government or commercial side). Note: IT operations are not the same as business operations.
At least four years experience in healthcare insurance IT software/systems implementations performing duties described in the "Daily Duties/Responsibilities" section above.
Ability to properly document business requirements.
Ability to create/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:
Understanding of the Medicaid Information Technology Architecture (MITA).
Understanding of the Medicaid Enterprise Certification Toolkit (MECT).
Experience with traditional Medicare or Medicare Advantage
Experience in an outsourced healthcare insurance operations environment.
Experience on an outsourced IT development project.
PUBLIC SECTOR/GOV'T EXPERIENCE REQUIRED?
– Not required, but preferred.
Database Platforms Agile Yes 1
Education Outsourced IT Development Project No 1
Miscellaneous Interpret business process and business data models Yes 1
MMIS - Medicaid Management Informaiton System Experience in State and Federal Medicaid financial reporting Yes 1
MMIS - Medicaid Management Informaiton System Healthcare Insurance Operations Yes 1
MMIS - Medicaid Management Informaiton System IT Healthcare Systems Yes 1
MMIS - Medicaid Management Informaiton System Medicaid Yes 1
MMIS - Medicaid Management Informaiton System MECT - Medicaid Enterprise Certification Toolkit No 1
MMIS - Medicaid Management Informaiton System MITA - Medicaid Information Technology Architecture No 1
Program Management Software Development Lifecycle - SDLC Yes 1
Program Management Waterfall Yes 1
Program Management - RUP methodology PLC - Project Life Cycle Methodology Yes 1
Program Management - RUP methodology Vendor management experience Yes 1
Specialties Financial Yes 1
Additional Skills:
Finance experience required on Project planning and financial budgeting
Training and experience in financial analysis and assessment;
Experience in the financial analysis of large health data systems;
Experience in state Medicaid MARS/SURS financial analysis and reporting;
Strong background and at least six years experience in healthcare insurance business operations (payer or provider side; government or commercial side). Note: IT operations are not the same as business operations.
Ability to properly document business requirements.
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.
Requirements gathering experience.
Experience with traditional Medicare or Medicare Advantage
Experience in an outsourced healthcare insurance operations envi
Please send resume to
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