Business Analyst with Medicaid/ Medicare/ MMIS Expertise - 100% Remote

Job Requirements

1. Candidate should have strong health care domain experience and should have good knowledge of Medicaid and Medicare.

2. Candidate should have hands-on experience on claims processing and adjudication processes.

3. Must have good experience in reference code/data sets required in claims adjudication.

4. Must have prior experience or understanding in configuring benefits or programs in claims system across various sub-systems.

5. Should be able to run queries and perform basic system analysis, RCA etc.

6. 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.

7. Must have excellent written and spoken communication skills. Should be able to multitask between internal team and clients based on priority tasks.

8. Work closely with Dev, architecture and design teams to define the GUI view and platform requirements, which is the foundation of the product.

9. In depth understanding of claims and claims lifecycle.

Technical Skills

SQL: To validate data in backend tables (e.g., claim status, payment details, find members/providers, benefit plan).

EDI Tools: Validating X12 files.

Interface Testing: Understanding how data flows between systems and formats and use tools like Postman.