Sr. Business Analyst - Medical Claims adjudication- ...

Job DescriptionJob DescriptionIncluded is an opportunity for multiple remote Sr. Senior Business Analyst with Medical Claims positions. The client is ruling out candidates that do not have Senior-level experience in Business and Systems Analysis, dealing with the end clients directly and often, strong Software Implementation, and medical claims experience - (must have claims processing / claims adjudication in EDI 837) in Agile methodology. There are multiple positions open and the client is moving fast with interviews.Please email resumes and contact information to bhealing@ to apply and submit your profile to this client with the required documentation. Brianna Healing on LinkedIn: order to be submitted:-2 recent managerial references with LinkedIn profiles provided to qualify.-Complete HackerRank Java assessment assigned ASAP. Senior Business Analyst with Medical Claims experience12 month contract - 100% RemoteW2 candidates only GC-EAD/ US CitizenTop Skills Details- 5-7+ years experience as a Business Analyst and Systems Analysis.- Experience working on Software Implementation projects.- Experience dealing with the end clients directly- and sometimes evoking requirements.- MUST have extensive medical claims experience - claims processing / claims adjudication REQUIRED.- Past experience acting in Consultative or Advisory with end clients and leading the requirements process.Enterprise Req SkillsBusiness Analysis, Excel, Medical Coding, Claims, claims processing / claims adjudication1. BSA experience- requirements gathering that includes changes to software2. Client facing- experience with client presentations and training3. Healthcare industry4. Analytical skills and problem solving- experience with working through a software defect and resolution5. Testing experience- created scenarios and performed some level of hands-on testing.- As this role is very customer-facing - We are looking for candidates that are enthusiastic, highly-engaged, and can interact with customers with ease.Ideal candidate would have all or most of the above.In summary strong customer-facing skills and good claims background, experience in requirements gathering, configuration and technical knowledge.Please email resumes and contact information to bhealing@ to apply and submit your profile to this client with the required documentation. Brianna Healing on LinkedIn: Claims Solution Consultant (CSC) is responsible for understanding their assigned clients claim systems and payment policies so they may document requirements for implementing services and rule engine components either during the initial and/or subsequent phase of implementation. They are also responsible for supporting their clients during maintenance periods which may require researching issues, analyzing software behavior and remediating defects. Will do a Logic test - Understand how the table flows - BULLION LOGIC / IF-WHEN / YES-NO - based on that you go to next path Looking for good detail - have questions - did research - prepared The main job is talking and interacting with customer - Customer facing Need to be Analytical BAs have to create test plans / test cases / test scenarios / test scripts - at least understand how and why they are written Work with developers Communication is key Financial background could also work Healthcare background is helpful - doesnt have to be claimsFor the CSC role, we mostly use excel for data mining within the content database. Some technical skills and some clinical/healthcare knowledge is preferred. The main skills needed are logical/analytical minds with excellent customer consulting skills.The Claims Solution Consultant must be an active consultative client facing participant within the assigned team structure to ensure quality client deliveries within targeted timeframes based upon work effort and allocation.Customers Business: Understands payor environments and claims management High level understanding of different customer segments (national, strategic and/or specialized business) High level understanding of claim architecture, infrastructure, and multiple platforms Discusses customer issues (pains and trends) confidently with customersClinical: Understands medical terminology, healthcare industry terminology and medical coding terminology Must be able to articulate the clinical value of products and services provided to clientsCommunication: Delivers presentations effectively to the customer Able to understand and articulate ClaimsXten rules development Conducts customer meetings/trainings efficiently and effectivelySoftware Tools High-level proficiency in the following software: Word PowerPoint Excel Visio Worksite AddressRemoteAdditional InformationPerm salary range is $75-90kFEEDBACK FROM MANAGER:Not doing a great job communicating their answers or not expressing the experience they thought they had.Skills would be very analytical. Recognize problem and figure it out yourself. Asking good questions. Pull requirements from clients is important. We really need them to have the testing. Something else shes seen lately would be the communication skills. If u dont understand requirement, talk to client. Few webex with interal HR. might do logic example during first call. Actual test not super important. Concerned with getting the right people. plan is still to convert them to FT.FROM OUR IALogic test - follow this decision given this data- every step of the way through that, he talked it through out loud, got one wrong but because he talked it through (the only misstep was he didnt quite understand the layout of the tables and not an actual problem with the logic) - they cared more about talking through your mental process versus the answer ; he rolled with it when he did get one wrong - that happens, Ill just fix it (he was quick to admit that he saw it from their perspective)Position is strongly client facingBeyond basic logic skills of the BA, he seemed comfortable and personable and someone that theyd feel comfortable having in front of the client; outgoing; comfort in front of people, relaxedHe was acting like a BA - he was asking questions about them and how their group and business modelHas a little healthcare experience - his experience wasnt really claims based, they seemed to care more about his core BA skillsJulia & Moses were very personable and talkativeHe was the only BA in most of his roles so doesnt have referralsThis person might be sitting in a hospital doing the medical coding - reading doctors notes from patients and coding them, along with the medical billing. The sell to them would be to get out of a hospital and into IT because they can make more money, and travel to client sites to implement this system."Medical Billing and Coding specialist", "CPC"CPC is Certified Professional CoderThey give a test of your data base skills. The one paper is testing there process flow skills, then there is a code table where they show you the medical code and you have to pick which one goes with their procedure, and the last paper had claims data and you had to determine whether the claim would deny or create an error.Drug Test Requiredtrue100% Remote Work:YesCan Use Approved Sub-Vendor / C22:False Job Description- 5-7+ years experience as Business Analyst and Systems Analysis- Extensive experience working with Medical Claims (EDI 837)- Strong experience client facing with external clients and leading the requirements process.Nice to have:-SQL query writing-data mapping, modeling, profiling, and warehousingEVPThis is a growing company in one of the fastest growing industries in the nation. They offer flexible hours and well as potential to work remote (contractors included).Work EnvironmentThis is a fast paced and deadline driven environment. Majority of the work will be on client sites as well as internally. Ability to adapt to different environments and work with different teams is a must. Additional Skills TagsClaims, claims processing / claims adjudication REQUIREDSkills & QualificationsMust have strong and effective communication and presentation skills for effective communication and presentation skills for external client facing as well as internal communications.1. Effectively work as a ClaimsXten rules development subject matter expert on client implementations of the software. This will require working consultatively with the client and documenting granular requirements for signature.2. Address all assigned client issues & requests that are generated through the Services Support Center - need someone to do the configurations in the claims systems per customer requests - not really programming per se but changing the application through the UI dictionary (Configuration work)3. Effectively participate or lead internal or external ClaimsXten Service Delivery Team meetings and initiatives. Conduct training as needed. Act as a mentor to less experience team members through their assigned tasks.4. Experience creating test plans including case scenarios that are positive and negative.Impact to the Internal/External CustomerHelp streamline the claims process for internal employees while simultaneously making claims easy and accessible for the customers. Interview Information2 step- Phone Screen and then WebEx video with the team. Business ChallengeWithout the claims system streamlined both the Payors and their customers are losing money. This allows for a smoother process both internally and externally.Please email resumes and contact information to bhealing@ to apply and submit your profile to this client with the required documentation.Brianna Healing on LinkedIn:

Created: 2025-04-24