Description

You will support Medicaid Management Information System (MMIS) solutions through requirements analysis and technical documentation.

Responsibilities

• Review requirements documentation to ensure accuracy for intended MMIS solutions.
• Develop system change requests and document defects within quality assurance testing tools.
• Conduct user acceptance testing (UAT), including test case and script development and execution.
• Participate in project team meetings and prepare weekly status reports.

Required Skills

• 5 years of experience as a Business Analyst.
• Experience with HIPAA X12 transactions (837I, 837P, 837D, 835, 276, 277, 270, 271, 834, 820).
• Proficiency in SQL for developing analytical queries.
• Experience with database management systems such as SQL Server or Oracle SQL.
• Experience with at least one programming or scripting language, such as Java.
• Knowledge of healthcare medical claims processing, including adjudication, submission, and editing.
• Familiarity with medical coding standards including ICD-10, HCPCS, and billing procedural/diagnosis coding.
• Experience with Medicaid member eligibility, benefit plan rules, and managed care enrollment.
• Proficiency in Microsoft Office tools including Word, Excel, and PowerPoint.

Preferred Skills

• Experience with NCPDP electronic claim transactions and pharmacy billing code standards.
• Knowledge of Generally Accepted Accounting Principles (GAAP) and Federal Financial Participation (FFP) rules.
• Experience with coordination of benefits, third-party claim subrogation, and member estate/lien processes.

Key Skills

Education

Any Graduate