Hi,

I am *Joseph* a Recruiter with Nuline Systems Inc. I do have a job opening
for you as *Business Analyst w/Healthcare*  in  *Columbia, SC.* If
interested please send me your word format resume at *
[email protected]*





*Position : Business Analyst w/Healthcare*

*Location : Columbia, SC*

*Duration : 12-Months*





*Description :*



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. The majority of the system development work will be outsourced
to vendors and other State organizations.



Duties include:

•  Requirements development execution, including the elicitation, analysis,
specification and validation.Documenting and analyzing agency business
processes and recommending improvements.

• Documenting and analyzing 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, financial management, reimbursement methodology, drug rebate,
prior authorization, managed care, behavioral health, long-term care,
program integrity, electronic health records, benefit plan administration,
etc.



Familiarity with ICD-9/ICD-10 coding standards, X12 EDI transactions, and
the Affordable Care Act and it impacts on Medicaid eligibility and health
insurance exchanges is also beneficial



*REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE):*



•  General Medicaid or Medicare Experience Required.

•  Strong background and at least six years experience in healthcare
insurance business operations (payer or provider side; government or
commercial side). Experience in multiple business areas is a plus. 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 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.



*PREFERRED SKILLS (RANK IN ORDER OF IMPORTANCE):*



•         Understanding of the Medicaid Information Technology Architecture
(MITA).

•         Understanding of the Medicaid Enterprise Certification Toolkit
(MECT).

•         Experience in an outsourced healthcare insurance operations
environment.

•         Experience on an outsourced IT development project.

•         Experience in creating business process and business data models.

•         Public sector procurement experience is a plus.



* *







*Thanks and Regards,*

*Joseph Adams*

Contact: 513-442-4187

Email ID: [email protected] <[email protected]>

www.nulinesystems.com

GTalk : Joseph.recruiter02 : IM : josephadams72

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