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Sogeti · 9 hours ago

Healthcare Business Analyst

United States

Full-time

Remote

Mid Level

Sogeti is a company focused on providing innovative solutions in the field of technology and consulting. They are seeking a Healthcare Business Analyst to create and maintain business requirements documentation, facilitate reviews, and assist project managers in planning and executing projects within the healthcare domain.

ConsultingInformation TechnologyProfessional ServicesSoftware

No H1B

Responsibilities

Create/maintain Business Requirements Document (BRD)

Create/Maintain Requirements Traceability Matrix (RTM)

Develop supporting diagrams (process flows, context diagram)

Develop business, functional & non-functional requirements

Facilitate Business Owner review

Build UAT scenarios

Provide input on client University project training plan

Provide input on project status report

Provide input on project change control

Assist Project Manager w/transition plan activities

Escalate issues/risks to Lead BA (if applicable) & Project Manager

Assist Business Owner with documenting current or future state process flows

Assist Project Manager to create operations & support plan

Obtain approvals on deliverables

Assist the project team in estimating the impact of change requests on timelines, budgets, resources and project scope

Develop requirements management plan (RMP)

Create/maintain Business Requirements Document (BRD) as necessary

Experience in using Azure Devops for product management lifecycle

Collaborate w/Integration Test Lead to create UAT scenarios

Assist Program Manager to create operations & support plan

Provide input on program status report

Provide input on program change control

Assist Program Manager w/transition plan activities

Escalate issues/risks to Program Manager

Mentor other BA’s in proper processes and standards

Qualification

Health Plan Provider expertiseClinical space backgroundElectronic Health Records (EHRs)Claims adjudication processHealthEdge's Guiding CareUtilization ManagementPharmacy operations knowledgeHEDIS understandingCare Management ExperienceSocial Determinants of HealthVendor onboarding processesCall Center Operations knowledgeProcess assessment skillsReporting databases understandingValue Based Reimbursement knowledgeHealth Information Exchange

Required

Expertise in Health Plan's Provider space -specifically Provider Information and Provider Data

Provider Demographics, Credentialing, Contracting, Fee schedule, and Hierarchy (provider, group, systems, etc), Provider Networking

Provider vendor onboarding processes

Strong E2E background in Health Plan in Clinical space

Knowledge of Clinical Policy

Knowledge of HealthEdge's Guiding Care system

Working with Electronic Health Records (EHRs)

Care Management Experience (Assessments, Statisfication, Letters)

Utilization Management (Channels, Codes, Turn Around Times, Policies), Prior auth

Process assessment for Clinical Vendor onboarding/extensions

Healthcare plan enrollments and EDI files

Pharmacy healthcare processes, Pharmacy operations and Data

Understanding of how Pharmacy claims are paid. Knowledge of Formularies, files exchange process with PBM's

Claims adjudication process. Understanding of claims data and systems (FACETS)

Understanding of claims billing practices

Understanding of compliance and regulatory reporting and CMS guidelines

Research reporting related requirements in state and federal contracts and regulations

Understanding of Program Integrity function and Reporting

Define processes for documentation of reporting requirements, sharing of reporting requirements with the larger team

Understanding of reporting databases

Understanding of Healthcare equity

Social Determinants of Health and processes with Community Based Org

Vendor discontinuation processes

Understanding of Health Information Exchange function

Knowledge of Call Center Operations

Understanding of HEDIS, Quality Management

Knowledge of Value Based Reimbursement and trends

Understanding of Electronic Visit Verification process

Facilitate requirements elicitation sessions

Benefits

Paid time off

Medical/dental/vision insurance

401(k)

Company

Sogeti

Glassdoor3.5

Part of the Capgemini Group, Sogeti makes business value through technology for organizations that need to implement innovation at speed and want a local partner with global scale.

Founded in 2007