Heathcare Claims SME (closed)

Baton Rouge, LA
Open compensation
Recruiter Comment: We are looking for a Healthcare Claims SME with Claims Processing experience for a long term opportunity in Baton Rouge LA . If interested email me your resume at firdosh.bhathena@cns-inc.com or call em at 301-634-4704.
Job Description

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

1)      Demonstrated leadership skills, initiative, team oriented, self-motivated

2)Functional responsibility during a DDI for Claims Processing and/or Reference business areas

 

Firdosh Bhathena
CNSI Inc
15800 Gaither Drive
Gaithersburg, MD 20877
firdosh.bhathena@cns-inc.com
Phone: (301) 634-4704
Alt. phone: (301) 634-4600
Fax: (301) 634-4621

Web: http://www.cns-inc.com