[xrecnet] Healthcare Business analyst :: Columbia, SC

Hi

 

Client-“State of SC”

 

Phone Hire

 

Location: Columbia, SC

Duration: 12+ months

Rate: Open

 

Description

A Replacement MMIS Subject Matter Expert (SME) 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. The majority of the system development work will be outsourced to vendors and other State organizations.

 

Subject matter areas include: provider management, member (beneficiary) management/eligibility, claims (professional, institutional, pharmacy, dental, durable medical equipment, transportation, etc.), third party liability, financial management, reimbursement methodology, drug rebate, prior authorization, managed care, behavioral health, long-term care, program integrity, electronic health records, benefit plan administration, etc.

 

 

Skills Needed

·         Familiarity with ICD-9/ICD-10 coding standards, X12 EDI transactions, and the Affordable Care Act and it impacts on Medicaid eligibility and health insurance exchanges is also beneficial.

• Analytics Background required

• Strong background and at least six years experience in healthcare insurance business operations (payer or provider side; government or commercial side). Note: IT operations are not the same as business operations.

• At least four years experience in healthcare insurance IT software/systems implementations.

• Ability to properly document business requirements.

• Ability to interpret business process and business data models.

• Vendor management experience.

• Willingness and ability to effectively engage with people and organizations on a continuous basis.

• Information Technology Architecture (MITA).

• Understanding of the Medicaid Enterprise Certification Toolkit (MECT).

• Experience in an outsourced healthcare insurance operations environment.

• Experience on an outsourced IT development project.

• Experience in creating business process and business data models.

• Public sector procurement experience is a plus.

 

Thanks,

 

Dinesh Kumar
Software People Inc.
www.softwarepeople.us

dinesh.kumar@softwarepeople.us,

Ph:  631- 739-8499

Fax: 631-574-3122

Certifications: SBA 8a/SDB, NJ MWBE, NY MWBE, VA SWaM, DE OMWBE, MA MWBE