Description

Key Experience:

• Strong knowledge and hands-on experience in Medical Claims Adjudication across multiple payers.
• Experience creating functional requirements documentation such as BRDs (Business Requirements Documents) and DSDs (Design Specification Documents).
• Experience configuring claims-related business rules based on policy, business, and technical requirements.
• Strong Healthcare domain experience is mandatory.
• Hands-on experience working with Electronic Health Records (EHR) and Electronic Medical Records (EMR) systems.
• Comprehensive understanding of healthcare business processes, payer-provider workflows, claims processing, and regulatory requirements.

Additional Experience:

• 2 to 5 years of experience as a Business Analyst, Systems Analyst, or related role working with information technology and business teams.
• Bachelor's degree in a technical or business discipline, or an equivalent combination of education and experience.
• Intermediate knowledge of requirements gathering, documentation, analysis, validation, traceability, prioritization, and change management.
• Ability to translate high-level business requirements into detailed functional and technical requirements.
• Experience with Long-Term Care (LTC), Inpatient, and Outpatient claims processing.
• Strong stakeholder management, communication, and client-facing skills.

Preferred Candidate Profile:

• Extensive experience in the Healthcare industry, with expertise in EHR/EMR platforms, Medical Claims Adjudication, and Claims Processing.
• Proven ability to gather business requirements, create detailed documentation, and work effectively with business and technical teams to deliver healthcare technology solutions

Key Skills

Education

Bachelor's degree