*Hiring: Business Aanalyst/Health Care / Columbia, SCDirect
ClientJob Title: Business Aanalyst/Health CareLocation: Columbia,
SCDuration: 12 MonthsClient: State of SCDirect Client
PositionDescripatyion: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
configurationEstablish 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 budgetingTraining 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, PLCRequirements
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 AdvantageExperience 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 budgetingTraining 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
AdvantageExperience in an outsourced healthcare insurance operations
envi Please send resume to [email protected]
<[email protected]>*
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