Heathcare Claims SME (closed)
1)Act as the Team lead by providing business and technical expertise and direction for the Claims Processing and Reference functional teams for MMIS (Medicaid management Information System)
2) Communicate status, issues, and risks to Functional manager
3) Lead a team of business analysts to validate requirements and conduct design to transfer a base system to meeting requirements of the customer.
4) Conduct requirements management activities
5) Update/maintain Requirements Specification and Detailed System
Design documents
6) Act as the Subject Matter Expert (SME) in Claims Processing and Reference
7) Participates in collaborative sessions to document Medicaid /MMIS businessprocesses
8) Review ongoingMITA assessments and assist in the development of processes to achieve higher MITA levels
9) Coordinate functional aspects with fiscal intermediary operations
staff and the Department
10) Resolve issues within and between business areas
11) Other duties as assigned
Required Skills:
1) Bachelor's degree from a four-year accredited college or university
2) Three (3) years full-time experience as a business analyst, systems analyst, programmer analyst or programmer or five (5) years of full-time experience as a systems analyst, programmer analyst, or programmer (experience in multiple roles listed above may be combined to meet requirement.
3) Three (3) years of full-time supervisor/management/SME experience in a Medicare or Medicaid/MMIS program or other large-scale medical claims processing system with emphasis on Claims Processing and Reference functionality (Edits/Audits/Business Rules development and analysis/rates,etc)
Desired Skills
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1) Demonstrated leadership skills, initiative, team oriented, self-motivated |
2)Functional responsibility during a DDI for Claims Processing and/or Reference business areas
