Senior Business Analyst

3 weeks ago

Philadelphia, United States Avance Consulting Full time
Job DescriptionJob Description

Key Responsibilities:
• Analyze Medicaid fee schedule requirements for various healthcare services across different states.
• Design and develop fee schedule configurations in collaboration with stakeholders, including Medicaid program managers, actuaries, and IT professionals.
• Implement and maintain fee schedules within the organization's claims processing system.
• Conduct thorough testing and validation of fee schedule implementations to ensure accuracy and compliance.
• Monitor fee schedule changes and updates from regulatory agencies and proactively address any impacts on existing configurations.
• Provide subject matter expertise on fee schedule-related inquiries and issues, and collaborate with internal teams to resolve them in a timely manner.
• Document fee schedule specifications, processes, and workflows, and provide training and support to end-users as needed.
• Expertise in creating BRD, FRD and Data Mapping documents such that Development can continue based on these artifacts.
• Analyze the existing table inventory in Synapse / Azure cloud platform pertaining to the Fee schedule .
• Strong Data Analysis using SQL queries to analyze the issues, patterns etc
• Exposure is working with data /data analysis on the MS Azure cloud platforms

Qualifications:
• Bachelor's degree in Healthcare Administration, Business Administration, Information Systems, or a related field.
• Minimum of [6] years of experience as a Business Systems Analyst, in the healthcare industry and specifically with Medicaid fee schedules.
• In-depth knowledge of Medicaid programs, fee schedules, reimbursement methodologies, and state-specific regulations.
• Proficiency in analyzing complex data sets and translating business requirements into technical specifications.
• Strong analytical, problem-solving, and decision-making skills.
• Excellent communication and interpersonal skills, with the ability to collaborate effectively with cross-functional teams.
• Experience with healthcare claims processing systems and software applications is preferred.
• Certification in Business Analysis (e.g., CBAP) or related field is a plus.

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