Adjudication, Business Analysis, Compensation and Benefits, Data Quality, Electronic Data Interchange (EDI), Finance, Healthcare, Medicaid, SQL (Structured Query Language), Test Data, Test Plan/Schedule, Test Scenario
- 10-12 years of experience as a Business Analyst with Minimum of 8+ years of experience in health care experience especially in MMIS domain.
- In depth understanding of Claims and Claims lifecycle:
- Claim submission – Paper and EDI X12
- Adjudication
- Payment Cycle (Finance)
- Reporting
- Encounters and Capitation
- EDI X12 formats like 837P/I/D
- X12 formats 835, 834, 270/271, 276/277
- Familiarity with systems like CMdS, GHS, Facets and etc
- Ability to validate Test scenarios and test plans, test data.
- SQL: To validate data in backend tables (e.g., claim status, payment details, find members/providers, Benefit Plan).
- EDI Tools: Validating X12 files.
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