Senior Business Analyst - Medicaid with ETL- Remote

Job TitleMinimum of 10+ years of experience as a Business Analyst with min 5+years in health care experience especially in MMIS domain.Strong health care domain experience and should have good knowledge of Medicaid and Medicare.Strong hands-on experience on claims processing and adjudication processes.Must have good experience in reference code/data sets required in claims adjudication.Must have prior experience or understanding in configuring benefits or programs in claims system across various sub-systems.Should be able to run queries and perform basic system analysis, RCA etc.Should be able to review requirements, documentation and create requirements traceability matrix (RTM).In depth understanding of claims and claims lifecycle:MemberProviderClaim submission – Paper and EDI X12AdjudicationPayment Cycle (Finance)ReportingClaim Types:ProfessionalDentalInstitutionalPharmacyEncounters and CapitationClaim Formats:EDI X12 formats like 837P/I/DX12 formats 835, 834, 270/271, 276/277Claim System: Familiarity with systems like CMdS, GHS, Facets and etcTechnical SkillsSQL: 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 The Dignify Solutions, LLC