*Business Analyst w/ Healthcare*


Pittsburgh, PA

Local or nearby

6-9 Months C2H



PROJECT:

Planning to perform a consolidation effort on its systems, with a
concentration on the MC400 claims platform. While the current
implementation is stable and has been performing the necessary operations,
the goals are to (i) improve the serviceability of the systems and (ii)
allow for scale and extensibility for additional functions and for
additional lines of business. Of particular interest is the development of
Third Party Administrator (TPA) lines of business which will require a more
“commercialized” approach to the services that these systems provide.



Experience Required:

*7+ years working for a health payer*

*5+ years claims processing experience*

*4+ years working in a Business Analyst capacity and documenting business
requirement*

*4+ years creating and executing claims, enrollment and/or billing test
scenarios, including defect tracking*

*Knowledge of medical terminology ICD-9, ICD-10 and CPT-4 coding knowledge*

*Knowledge of claims coding, benefits, coordination with other payers, and
provider pricing*

*Advanced problem solving skills*

*Detail oriented with excellent organizational skills*

*Proficiency using advanced office tools such as Excel, Macros, Access and
extensive PC skills*

*Provide service to the client while protecting the integrity and
confidentiality of all data and information through physical and electronic
measures (HIPAA)*

*Participate in all required training to develop a thorough understanding
of the materials related to the MC400 Merge Application*

*Ability to document and communicate issues associate with your work and
test result findings*

*Understands the client’s business needs related to operational payer
departments (i.e. claims, enrollment, billing, etc.)*



Primary Responsibilities:

Gather business requirements using UML, process flows and use cases

Create written business requirement documentation

Review requirements with team and create user stories with acceptance
criteria

Work with the delivery team for clarifications, questions and acceptance

Act as a liaison between delivery team and business

Involve in UAT test design and execution. Log defects in Test management
tools


*Randhir Kumar*



*IDC Technologies, Inc Mailto: [email protected]
<[email protected]> _____________________________________*

*Empowering Technologies Services*

*Remote Services | IT Services | BPO | *

*IT Consulting | Staffing Solutions |*

*_____________________________________*

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