Consultant

Job Description

• Strong knowledge of managed care payer requirements, operational improvements and procedures.
• Should be an experienced Business Analyst in the Healthcare Industry on various areas like Claim Processing, Billing/Invoicing, and Customer Care.
• Position requires Knowledge and experience in full SDLC with agile and waterfall methodologies.
• Expertise needed in EDI and HIPAA Testing Privacy with multiple transactions exposure such as 837 for submitting claims, 835 for payments, 834 for benefit enrollment, and 820 for premium payments to insurance products, 270, 271 for healthcare benefits and eligibility, 276, 277 for claims status and 278 for transmitting health care service information.
• Knowledge in ETL (Extract, Transform and Load) of data into a data ware house/date mart and Business Intelligence (BI) tools like Business Objects Modules
• Analyst should be able Identify Member, Payers, Provider, Coverage, Medicare, and Medicaid.
• Should be able to Write, update and groom Use cases, to come up with detailed Requirements..
• Need extensive experience with Members/Subscribers, Products, Providers, Claims processing and Billing modules.
• Should be able to Identify gaps and performed gap analysis in requirements and come up with recommendations to improve processes.
• Need Extensive experience in developing use cases, creating screen mockups, conducting gap analysis and impact analysis, SWOT analysis, risk analysis.
• Should perform Design and review of various documents including the Software Requirement Specifications (SRS), Business requirements document (BRD), Use Case Specifications, Functional Specifications (FSD), Systems Design Specification (SDS), Requirement Traceability Matrix (RTM) and testing documents.
• Claims or reconciliation experience
• Experience that includes data analysis, not just business analysis
• Solid Visio and process mapping experience
• Experienced in collecting report requirements and creating report specifications.
• Good understanding of data analysis and various database systems