Healthcare/financial BA with Provider Enrollment/Management/reimbursement, Claims Payment, Financial systems, GL, insurance, Agile and MMIS/MITA/Medicaid Experience

Job Id: ePC-8379-1 (98891003)

Healthcare/financial BA with Provider Enrollment/Management/reimbursement, Claims Payment, Financial systems, GL, insurance, Agile and MMIS/MITA/Medicaid Experience

Location: Columbia, SC
Duration: 12 Months

REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE):

• Desired 6 years of experience in Provider Enrollment and Management, Claims Payment and Financial systems, but manager would look at someone with less. The more the better
• 4 years of experience with Medicaid budget assignments and financial general ledger reporting
• 3 years of experience in healthcare insurance business operations (payer or provider side; government or commercial side) with a focus on provider enrollment and provider reimbursement
• 3 years of experience in Financial Management

PREFERRED SKILLS (RANK IN ORDER OF IMPORTANCE):
• Understanding of the Medicaid Information Technology Architecture (MITA)
• Provider outreach and education
• Agile project methodology

REQUIRED EDUCATION:
Bachelor’s degree.

Category Name Required Importance Level Last Used Experience
Administrative Verbal Communication Skills Yes 1 Lead Currently Using 6 + Years
Administrative Written Communication Skills Yes 1 Lead Currently Using 6 + Years
Education BA Degree- Technical, Business, or Healthcare field Yes 1 Lead Within 10 Years 4 – 6 Years
Financial Claims Payment and Financial systems Yes 1 Lead Currently Using 2 – 4 Years
MMIS – Medicaid Management Informaiton System Healthcare Insurance – Business Operations Yes 1 Lead Currently Using 2 – 4 Years
MMIS – Medicaid Management Informaiton System • Experience with the Medicaid Information Technology Architecture (MITA) principles and framework No 1 Intermediate Within 2 Years 1 – 2 Years
Program Management financial management Yes 1 Lead Currently Using 2 – 4 Years
Program Management Agile/Scrum Methodology No 1 Intermediate Within 2 Years 1 – 2 Years

DAILY DUTIES / RESPONSIBILITIES:
The Provider Services Business Analyst (BA) is responsible for evaluating agency needs, as-is and to-be business processes, and technical designs to provide analysis and advice on strategies for information technology solutions and non-technical solutions. Most of the system development work will be outsourced to vendors and other State organizations.

Duties include:
• Requirements development execution, including the elicitation, analysis, specification and validation;
• Modeling Provider enrollment and payment business processes (As-Is and To-Be) through sequence
diagrams, business process models, etc.;
• Documenting and analyzing agency business processes and recommending improvements;
• Documenting and analyzing provider enrollment and financial requirements and relationships;
• Participate in the requirements management processes, including change control; version control; tracking
and status reporting; and traceability;
• Providing requirement interpretation and guidance to technical and test teams;
• Proactively identifying risks, issues, and action items leading to possible solutions;
• Interacting with internal and external organizations (i.e. vendors, State and Federal government agencies,
State providers and beneficiaries, and other stakeholders).
• Planning for, conducting, and reporting on testing and other quality assurance activities;
• Other related activities.

Subject matter requirements include:
• Medicaid or Medicare provider enrollment and management;
• Claims processing and payment;
• State budget assignments;
• Financial management;
• Provider reimbursement methodology

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