Business Analyst with web applications, SQL, Agile, QA and Healthcare Pharmacy Claims Processing experience

Job ID: NC-603175 (95390813)

Business Analyst with web applications, SQL, Agile, QA and Healthcare Pharmacy Claims Processing experience

Location: Raleigh NC (NCDHHS)
Duration: 12+ months
Interview: In Person Only
Positions: 1 (1/2)

Experience with Healthcare Pharmacy Claims Processing Required 3 Years
Experience in the review, analysis and reporting of test results. Required 5 Years
Experience on testing web applications Required 5 Years
Excellent verbal and written communication skills with the ability present to both technical and business audiences. Desired
Proven experience developing SQL queries. Required 2 Years
Knowledge of Agile Methodology Highly desired 3 Years
Experience in working with the Business Teams to write Business and QA Documents . Required 3 Years
Experience in validating all pharmacy interfaces/files Required 3 Years

NC Dept of Health and Human Services (DHHS) is seeking a Senior Pharmacy BA Lead to perform Business Analysis work related to support the Managed Care Transition Project.

This position is responsible for the following activities :
• Demonstrated knowledge in creating test scenarios/cases in consultation with the business owners, hands-on testing, test results review, and proactively identifying issues and providing resolutions/recommendations
• Proven knowledge in Medicaid or similar claims ( pharmacy) processing systems
• Extensive knowledge of pharmacy claims and business policies
• Thorough knowledge of system functional areas such as recipient, provider, prior authorization, reference, program integrity, financial and claims
• Thorough knowledge of Federal and State regulations, statutes, and rules
• Knowledge base/experience with encounter claims and be ready to lead any work effort pertaining to encounter claims
• Expert knowledge on SQL, EDI, X12, NCPDP, HL7, HIPAA PHI, ICD-10
• Clear understanding of the deliverables process, e.g. System Documentation release,
• Working knowledge of defect process
• Proven experience with the system development life cycle (SDLC)
• Experience working on large Federal/State contracts
• Proficient with Microsoft Word, Excel, Visio, Project, OneNote, Outlook, and PowerPoint


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