Technical Business Analyst
Posted Today by Omega Hires
Negotiable
Undetermined
Remote
Remote
Summary: The Technical Business Analyst role focuses on leveraging extensive experience in the healthcare payer domain to gather and document requirements for claims processing systems. The position requires collaboration with clients and IT teams to ensure effective implementation of solutions, along with a strong emphasis on communication and multitasking. The role also involves understanding various healthcare coding systems and the ability to analyze and validate data. Travel to Atlanta is required for approximately 25% of the time.
Key Responsibilities:
- Understand the healthcare payer space with a minimum of 10 years of experience.
- Implement and maintain commercial payer claims solutions and/or Medicare/Medicaid systems.
- Experience with claims processing concepts, provider and member enrollment, and care management.
- Knowledge of reference codes/data sets required in claims adjudication, including CPT, CDT, HCPCS, ICDs.
- Configure benefits or programs in claims systems across various sub-systems.
- Create and document requirements according to standards.
- Define processes for requirement solicitation, documentation, and hand-off.
- Collaborate with IT development teams to clarify requirements and facilitate discussions.
- Basic understanding of web services and relational databases.
- Run queries and perform basic system analysis and root cause analysis.
- Create mapping documents for interfaces, including business rules and DB mapping.
- Conduct demos during development stages and track feedback.
- Excellent written and spoken communication skills; multitask between internal teams and clients.
- Work with development, architecture, and design teams to define GUI view and platform requirements.
Key Skills:
- 10 years of experience in the healthcare payer domain.
- Experience in claims processing and Medicare/Medicaid systems.
- Knowledge of healthcare coding systems (CPT, CDT, HCPCS, ICDs).
- Ability to gather and document requirements.
- Strong communication skills (written and spoken).
- Basic understanding of web services and relational databases.
- Experience with system analysis and creating mapping documents.
- Capability to think creatively for new solutions.
- Prior experience in IT QA or development in healthcare systems (preferred).
- Familiarity with tools like MS Visio, Jira, TFM, DevOps Azure.
Salary (Rate): undetermined
City: undetermined
Country: undetermined
Working Arrangements: remote
IR35 Status: undetermined
Seniority Level: undetermined
Industry: Other
Detailed Description From Employer:
Job Role: Technical Business Analyst
Work mode: Remote with travel to Atlanta (25%)
Job Description:
Responsibilities
1. Must have very good understanding of the healthcare payer space with a minimum experience of 10 years in the domain.
2. Must have a prior experience in implementing/maintenance of commercial payer claims
solution and/or Medicare/Medicaid system
3. Must have good experience with claims processing concepts, along with the provider, member enrolment and care management concepts.
4. Must have good experience in Reference code/data sets required in Claims adjudication
including not limited to CPT, CDT, HCPCS, ICDs.
5. Must have prior experience or understanding in configuring benefits or programs in claims
system across various sub-systems.
6. Must be able to work with the clients to create/gather requirements and document them
according to standards.
7. Must adhere to (or if needed, define) the processes for requirement solicitation, documentation
and hand off.
8. Should work closely with the IT development team to elucidate the requirements, enable
constructive discussions / brainstorming sessions to implement the best in class solution.
9. Should have basic understanding concepts like web services, relational databases etc.,
10. Should be able to run queries and perform basic system analysis, RCA etc.,
11. Should be able to create mapping documents for the various interfaces and include business
rules, transformation and DB mapping.
12. Should work closely with the client and development team during the stages of development,
and conduct demos at completion of milestone, track and close feedback from such demos
13. Must have excellent written and spoken communication skills. Should be able to multitask
between internal team and clients based on priority tasks
14. Work Closely with Dev, architecture and Design teams to define the GUI view and platform
requirements, which is the foundation of the product.
Preferred skills:
1. Capability to think out-of-the-box to create new solutions as needed.
2. Prior experience as a IT QA or Developer in a healthcare system would be helpful though not
mandatory.
3. Ability to validate Test scenarios and test plans, test data.
4. Should be able to Review requirements, documentation and create Requirements Traceability
matrix (RTM)
5. Should have excellent communication (written and spoken ) skills to engage with different
stake holders like QA/dev team, clients, end users of Clients and Business Units.
6. Ability to assess current functionality available in a product vis a vis market trends, regulatory
requirements to be implemented in future version of the product.
7. Ability to drive and share the requirements with Technical and Architects regarding product
features to be implemented.
Optional Tools usage
1. MS Visio to define the different views like System, technical, functional and role based view.
2. Awareness defect tracking and version control tools like Jira, TFM, DevOps Azure
3. DB client to write data queries to validate data updated in the database table.
1. Must have very good understanding of the healthcare payer space with a minimum experience of 10 years in the domain.
2. Must have a prior experience in implementing/maintenance of commercial payer claims
solution and/or Medicare/Medicaid system
3. Must have good experience with claims processing concepts, along with the provider, member enrolment and care management concepts.
4. Must have good experience in Reference code/data sets required in Claims adjudication
including not limited to CPT, CDT, HCPCS, ICDs.
5. Must have prior experience or understanding in configuring benefits or programs in claims
system across various sub-systems.
6. Must be able to work with the clients to create/gather requirements and document them
according to standards.
7. Must adhere to (or if needed, define) the processes for requirement solicitation, documentation
and hand off.
8. Should work closely with the IT development team to elucidate the requirements, enable
constructive discussions / brainstorming sessions to implement the best in class solution.
9. Should have basic understanding concepts like web services, relational databases etc.,
10. Should be able to run queries and perform basic system analysis, RCA etc.,
11. Should be able to create mapping documents for the various interfaces and include business
rules, transformation and DB mapping.
12. Should work closely with the client and development team during the stages of development,
and conduct demos at completion of milestone, track and close feedback from such demos
13. Must have excellent written and spoken communication skills. Should be able to multitask
between internal team and clients based on priority tasks
14. Work Closely with Dev, architecture and Design teams to define the GUI view and platform
requirements, which is the foundation of the product.
Preferred skills:
1. Capability to think out-of-the-box to create new solutions as needed.
2. Prior experience as a IT QA or Developer in a healthcare system would be helpful though not
mandatory.
3. Ability to validate Test scenarios and test plans, test data.
4. Should be able to Review requirements, documentation and create Requirements Traceability
matrix (RTM)
5. Should have excellent communication (written and spoken ) skills to engage with different
stake holders like QA/dev team, clients, end users of Clients and Business Units.
6. Ability to assess current functionality available in a product vis a vis market trends, regulatory
requirements to be implemented in future version of the product.
7. Ability to drive and share the requirements with Technical and Architects regarding product
features to be implemented.
Optional Tools usage
1. MS Visio to define the different views like System, technical, functional and role based view.
2. Awareness defect tracking and version control tools like Jira, TFM, DevOps Azure
3. DB client to write data queries to validate data updated in the database table.