Technical Business Analyst

Role Overview

• 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 systems 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.

Requirements

• 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 systems 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.
• 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 stakeholders 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.