Gainwell Technologies · 4 hours ago
Experienced Business Analyst - Claims Configuration - QNXT
Texas, United States
Contract
Remote
Senior Level
$69K/yr - $99K/yr
6+ years exp
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Responsibilities
Analyzes client requests and applies advanced subject matter knowledge to solve complex business issues and is regarded as a subject matter expert
Adheres to and supports Configuration team approach and other configuration principles, methodologies, and practices
Ensures communication among all key stakeholders
Exercises significant independent judgment within broadly defined policies and practices to determine best method for accomplishing work and achieving objectives
May provide mentoring and guidance to lower-level employees
Works closely with the Configuration team to analyze and determine if business rules cannot be configured within the system. If cannot be configured, communicates the rules via a Stored Procedure Specification Document so a Custom Stored Procedure can be developed
Creates test cases from functional requirements, executing test cases, and documenting results. Participates in technical reviews and inspections to verify 'intent of change' is carried out through the entire project
Provide accurate status and time reporting for project related tasks
Ability to read Custom Stored procedures
Medicaid Systems work experience
Ability to exercise discretion and independent judgment
Analyzes configuration data and structure to isolate defects
Research and define solutions for new configuration, legislation, or client rules
Creates proof of concept testing for new business processes or outcome requests
Creates and presents solution, proof of concept, or testing results to customer
Completes configuration within schedule timelines and configuration best practices
Qualification
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Required
Six or more years of business analysis experience
Ability to create and maintain highest levels of confidentiality when dealing with proprietary or private information
Four or more years’ experience configuring in QNXT: Contracts/benefits, Claims Pricing methodologies, System data points needed for successful X12 transactions, Claim Adjustment Reason Codes and Remittance Advice Code, Contracts for provider services, benefits for member coverage, fee schedules, capitation, and claim editing enforcement
Experience working with Medicaid/MMIS systems
Experience processing Medicaid claims and ability to troubleshoot adjudication results
Understands Medicaid Program structure in carriers, programs, benefit plans, policy, policy plans, sponsor, and orgpolicies
Understands Provider (Contract and Pricing) data including but not limited to provider type, specialty, taxonomy, enrollment impacts, service locations, certifications and licensing, affiliations, and reimbursement impacts
Understands Member data including but not limited to aid categories, coverage codes, benefit packages, restrictions, limitations, prior authorizations, programs, and primary care providers
Experience with Configuration Implementation Build & Maintenance
Bachelor's degree or equivalent combination of education and experience. Bachelor's degree in business administration, information systems, or related field preferred
Highly proficient in the use of Microsoft Office Products (PowerPoint, Excel, Word, Visio, Outlook)
Experience writing SQL queries for data analysis
Experience working with complex systems at a detailed level
Understands relational database concepts and schemas
Demonstrated aptitude for learning new technologies and keeping current with industry best practices
Ability to exercise sound judgment and make decisions in a manner consistent with the essential job functions
Ability to manage multiple priorities ensuring deadlines are achieved
Ability to work in a remote environment, self-directed with minimal supervision
Regular and reliable attendance is an essential function of this position
Preferred
Preferred experience working with HP Application Lifecycle Management (ALM)
Preferred experience includes DDI (Design, Development, and Implementation) and operations phases
Benefits
Flexible vacation policy
401(k) employer match
Comprehensive health benefits
Educational assistance
Leadership and technical development academies
Company
Gainwell Technologies
Gainwell Technologies is a provider of Information Technology & Services. It is a sub-organization of Veritas Capital.
10,001+ employees
H1B Sponsorship
Gainwell Technologies has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2023 (37)
2022 (101)
2021 (55)
2020 (2)
Funding
Current Stage
Late StageTotal Funding
$1M2023-06-08Grant· $1M
Leadership Team
Paul N. Saleh
President and Chief Executive Officer
Jacob Sims
EVP and Chief Technology Officer
Recent News
Texas CEO Magazine
2024-06-04
Company data provided by crunchbase
