[Hiring] Claims Business Analyst @GroupNine

Role Description

Business Analyst II responsible for configuring accounts receivable and payable processing tasks, assessing client operations, and developing new processes.

• Configure accounts receivable processing tasks, including:
• Setting up accounts receivable
• Developing report specifications for accounts receivable
• Assessing client AR business operations
• Configuring or developing new processes for the financial system
• Experience in Provider Recoupment in a Payer setup
• Manage Recoveries and AR funds
• Configure accounts payable processing tasks, including:
• Setting up accounts payable
• Developing report specifications for accounts payable
• Discussing with clients to understand their accounts payable operations
• Knowledge in the following business processes:
• Manage contractor payments
• Manage AP disbursement
• Familiar with 1099 Process
• Fiscal Management
• Budget Management
• Manage Funds
• Compare current reports (accounts receivable, accounts payable, cash receipts, etc.) with client-specific reports to identify gaps.
• Prior experience in implementing/maintenance of commercial payer claims solution and/or Medicare/Medicaid system.
• Good experience with claims processing concepts, provider, member enrollment, and care management concepts.
• Experience in Reference code/data sets required in Claims adjudication including CPT, CDT, HCPCS, ICDs.
• Prior experience or understanding in configuring benefits or programs in claims system across various sub-systems.
• Work with clients to create/gather requirements and document them according to standards.
• Adhere to (or define) processes for requirement solicitation, documentation, and hand-off.
• Work closely with the IT development team to elucidate requirements and enable constructive discussions.
• Basic understanding of concepts like web services, relational databases, etc.
• Run queries and perform basic system analysis, RCA, etc.
• Create mapping documents for various interfaces including business rules, transformation, and DB mapping.
• Work closely with the client and development team during development stages and conduct demos at milestone completion.
• Excellent written and spoken communication skills; able to multitask between internal teams and clients.
• Work closely with Dev, architecture, and Design teams to define GUI view and platform requirements.

Qualifications

• Capability to think out-of-the-box to create new solutions as needed.
• Prior experience as an IT QA or Developer in a healthcare system (helpful but not mandatory).
• Ability to validate test scenarios, test plans, and test data.
• Review requirements, documentation, and create Requirements Traceability Matrix (RTM).
• Excellent communication skills to engage with different stakeholders like QA/dev team, clients, end users, and Business Units.
• Ability to assess current functionality available in a product vis-a-vis market trends and regulatory requirements.
• Ability to drive and share requirements with Technical and Architects regarding product features to be implemented.

Optional Tools Usage

• MS Visio to define different views like System, technical, functional, and role-based view.
• Awareness of defect tracking and version control tools like Jira, TFM, DevOps Azure.
• DB client to write data queries to validate data updated in the database table.