11 Feb
Healthcare Business Analyst with Risk Adjustment MUST
Vacancy expired!
- Should have worked with Blue Cross Blue Shield in RAQ (Risk, Adjustment and Quality) area
- Out of Area (OOA) Network process
- Claims adjudication
- 10+ of IT exp. and 7+ years of experience working in an operations role at a health plan
- 4+ years of Healthcare experience in any of the following:
- Government Programs, Core Administer Delivery, Program Management, Product Management, or Network Management
- 2+ years of experience in one or more of the following:
- Operational business process improvement, business process analysis, benchmark analysis or workflow analysis
- Ability to work on claims with different LOBs such as Commercial, Medicare, Medicaid etc.
- Knowledge and experience of Medicare & Medicaid state level reporting levels
- Strong Knowledge/Experience with Dimensional Modeling
- Strong understanding of healthcare data formats, standards, and can map them to CMS and state level reporting needs
- Good understanding on the lifecycle of claims adjudication
- Possess good exposure on the various claim functionalities such as Edits, COBs, claims/ Risk adjustments, Episodes etc
- Healthcare Business Analyst translates business needs into clearly defined and documented detailed, high quality requirements and/or supplemental specifications for new applications or analyzes change requests/enhancements in existing applications.
- Analyzes data to determine business problems.
- Handles information including patient services and how the services are paid after conducting investigations and pursuing recoveries through contact with various parties.
- Works collaboratively within or outside the team to identify charge system weakness, to recommend changes and focused education.
- Will also ensure adherence to compliance policies and contracts. Knowledge and experience of Medicare & Medicaid.
Vacancy expired!