Job Description

Candidate requirement:
a. 2+ years of experience in claims payment, finance or financial review capacity
b. 2+ years of experience working with Medicare or Medicaid plans
c. 1+ years of experience using SQL and/or relational database
d. Proficient skillset in Microsoft Office applications Word, Excel Access
e. Experience prioritizing initiatives based on business needs and requirements.
f. Experience monitoring deliverables and ensuring timely completion of assigned tasks.

Preferred Qualifications:
a. 1-2 years of experience using Trizetto Facets
b. 1-2 years of EDI experience (835, 837, 820)

Role & responsibilities:

a. Works with BSA Team and Business Area to define stakeholder and solution requirements
b. Partners with Program Manager to validate scope and assumptions
c. Performs data analysis and provide guidance on data that needs scrubbing
d. Creates SQL queries to manipulate and manage data
e. Evaluate data to ensure that the conversion rules match the requirements
f. Elicits, analyzes and documents requirements and functional design/solutions that align with and achieve the business needs
g. Organizes, validates and takes ownership of all assigned requirements and deliverables
h. Serves as a trusted expert advisor or Subject Matter Expert for analysis and process design services
i. Develops process flows to enable the understanding the business future needs

Eligibility Criteria:
a. 2+ years of experience in claims payment, finance or financial review capacity
b. 2+ years of experience working with Medicare or Medicaid plans
c. 1+ years of experience using SQL and/or relational database
d. Proficient skillset in Microsoft Office applications Word, Excel Access
e. Experience prioritizing initiatives based on business needs and requirements.
f. Experience monitoring deliverables and ensuring timely completion of assigned tasks.