Technical Business Analyst

Job Title

Must have very good understanding of the healthcare payer space with a minimum experience of 10 years in the domain.

Must have a prior experience in implementing/maintenance of commercial payer claims solution and/or Medicare/Medicaid system

Must have good experience with claims processing concepts, along with the provider, member enrolment and care management concepts.

Must have good experience in Reference code/data sets required in Claims adjudication including not limited to CPT, CDT, HCPCS, ICDs.

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

Must be able to work with the clients to create/gather requirements and document them according to standards.

Must adhere to (or if needed, define) the processes for requirement solicitation, documentation and hand off.

Should work closely with the IT development team to elucidate the requirements, enable constructive discussions / brainstorming sessions to implement the best in class solution.

Should have basic understanding concepts like web services, relational databases etc.

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

Should be able to create mapping documents for the various interfaces and include business rules, transformation and DB mapping.

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

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

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