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Technical Business Analyst with Medicaid & Claims Module experience - Remote

The Dignify Solutions, LLC

  • Jersey City, NJ
  • 30+ days ago
  • Remote

    Highlights

    10-12 years of experience as a Business Analyst with Minimum of 8+ years of experience in health care experience especially in MMIS domain. SQL: To validate data in backend tables (e.g., claim status, payment details, find members/providers, Benefit Plan).

    Numbers & Facts

    LocationJersey City, NJ (
    Remote    )

    Description

    • 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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