Claims Business Analyst (Healthcare Payer)

Business Analyst II

Responsibilities

• Configure accounts receivable processing tasks including setting up accounts receivable, developing reports specifications to on accounts receivables. Assess client AR business operations and configure or develop new processes for configuring the financial system. Knowledge in the following business processes:
• Experience in Provider Recoupment in a Payer setup
• Manage Recoveries
• Manage AR funds
• Configure accounts payable processing tasks including set up accounts payable, developing reports specifications for accounts payable. Discuss with client to understand their accounts payable operations and configure financial system according to the client processes. 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 and other payment related etc.) with client specific reports to identify the gaps.

1. Must have a prior experience in implementing/maintenance of commercial payer claims solution and/or Medicare/Medicaid system
2. Must have good experience with claims processing concepts, along with the provider, member enrolment and care management concepts.
3. Must have good experience in Reference code/data sets required in Claims adjudication including not limited to CPT, CDT, HCPCS, ICDs.
4. Must have prior experience or understanding in configuring benefits or programs in claims system across various sub-systems.
5. Must be able to work with the clients to create/gather requirements and document them according to standards.
6. Must adhere to (or if needed, define) the processes for requirement solicitation, documentation and hand off.
7. Should work closely with the IT development team to elucidate the requirements, enable constructive discussions / brainstorming sessions to implement the best in class solution.
8. Should have basic understanding concepts like web services, relational databases etc.
9. Should be able to run queries and perform basic system analysis, RCA etc.
10. Should be able to create mapping documents for the various interfaces and include business rules, transformation and DB mapping.
11. 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
12. Must have excellent written and spoken communication skills. Should be able to multitask between internal team and clients based on priority tasks
13. 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:

• Capability to think out-of-the-box to create new solutions as needed.
• Prior experience as a IT QA or Developer in a healthcare system would be helpful though not mandatory.
• Ability to validate Test scenarios and test plans, test data.
• Should be able to Review requirements, documentation and create Requirements Traceability matrix (RTM)
• 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.
• 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.
• 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.