Job ID: |
Roles And Responsibilities:
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.
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.
Analytics Background required.
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.
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.
DatamanUSA, LLC - 18 months ago
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