Category: Curator- Job Hunter

 
 

This is investigative work involving the interpretation of policy to determine Medicaid eligibility for families and children and aged, blind, and disabled individuals. The incumbent makes the initial and continuing determinations of eligibility for Medicaid recipients who live in private and institutional settings. Limited supervision is received from administrative supervisors who oversee a regional office or Central Enrollment Office. Examples of Work: Examples of work performed in this classification include, but are not limited to, the following: Assumes responsibility for a Medicaid eligibility determination caseload for a designated territory within a region.Investigates and verifies accuracy of information provided by recipients under the Medicaid programs to determine compliance with State and Federal laws, rules, and regulations. Determines an applicant’s eligibility for institutional care based on State and Federal guidelines and verifies the accuracy of information listed on the applicants’ applications. Maintains effective public relations with medical facilities and federal, state, county, and city agencies within assigned territory. Verifies accuracy of information listed on applicants’ applications including income, bank accounts, and any other assets. Makes determination of an applicant’s eligibility based upon established criteria. Visits contact centers and medical facilities; assists other regional offices on an as-needed basis.Performs related or similar duties as required or assigned. Minimum Qualifications: These minimum qualifications have been agreed upon by Subject Matter Experts (SMEs) in this job class and are based upon a job analysis and the essential functions. However, if a candidate believes he/she is qualified for the job although he/she does not have the minimum qualifications set forth below, he/she may request special consideration through substitution of related education and experience, demonstrating the ability to perform the essential functions of the position. Any request to substitute related education or experience for minimum qualifications must be addressed to the Mississippi State Personnel Board in writing, identifying the related education and experience which demonstrates the candidate’s ability to perform all essential functions of the position.EXPERIENCE/EDUCATIONAL REQUIREMENTS: Education :A Bachelor’s Degree from an accredited four-year college or university.OR Education :An Associate’s Degree or completion of sixty (60) semester hours from an accredited college or university;AND Experience :Two (2) years of experience related to the described duties. Substitution Statement :Above an Associate’s Degree or completion of sixty semester hours from an accredited college or university, related education and related experience may be substituted on an equal basis. Essential Functions: Additional essential functions may be identified and included by the hiring agency. The essential functions include, but are not limited to, the following:1. Maintains caseload for Medicaid eligibility.2. Maintains good public relations and customer service.3. Collects eligibility data information.4. Visits Medicaid contact centers and/or long-term care facilities.

 
 

Clipped from: https://www.linkedin.com/jobs/view/medicaid-specialist-i-jackson-at-mississippi-state-personnel-board-2410484039/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

RICEFW Technologies Inc Jackson, MS

Job Description:

Participates in Joint Application Design (JAD) sessions, Detailed Design reviews, Agile sessions, project status

meetings and any other Medicaid project meetings, as necessary.

Participates in user acceptance testing by performing tests, analyzing, and documenting defects and issues.

Tracking identified issues and action items. Resolving issues and action items by following up with policy and vendors.

Required Skills/Experience

Provide the minimum required skills and/or experience the contractor must possess to qualify for this position. These requirements will be transferred to the Score Sheet and candidates without these requirements reflected on their resume will NOT be presented to the manager for consideration.

Years

Required Skills/Experience

2+yrs.

Experience with Federally sponsored benefit programs such as Medicaid, SANP, TANF

2+yrs.

Understanding of basic database principles

2+yrs.

Familiarity with and have participated in Joint Application Design (JAD) and/or Agile sessions

2+yrs.

Experienced in reviewing technical deliverable documents

2+yrs.

Experience with, understanding and maintenance of Requirements Traceability Matrix (RTM)

2+yrs.

Ability to write, execute and analyze results of test cases for multiple software applications

2+yrs.

Must be knowledgeable in the software System Development Life Cycle (SDLC) including the principles and practices of information systems analysis, design, development, implementation, maintenance, and security related functions.

N/A

Ability to document process flows and complex business requirements

N/A

Must have strong analytical and problem-solving skills

N/A

Must have experience in software testing including the following: Test plans, recording defects, assessing the severity of defects and documenting resolution of defects

N/A

Experience as a Business Analyst with Medicaid Eligibility Determination Systems

 
 

Clipped from: https://www.ziprecruiter.com/c/RICEFW-Technologies-Inc/Job/Business-Analyst-Medicaid/-in-Jackson,MS?jid=1fca4729e4146dc0&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Medical Mutual Cleveland, OH

Responsibilities

Directs Clinical Quality Management Programs for assigned functional areas Healthcare Effectiveness Data and Information Set (HEDIS), Disease Management and Wellness Promotion, Provider Quality, for Medicaid.  Oversees the analysis of the quality of member care and the development and implementation of programs that support continues quality improvement.  Establishes strategic plans, policies and procedures and collaborates with departments Companywide to ensure quality programs meet Company and regulatory requirements.

• Manages the strategies of the health plan’s clinical quality improvement department, including the activities for HEDIS, Medicaid and Provider Quality.
• Formulates and executes strategies that improve clinical outcomes and promote wellness for all lines of business, including managing the health plan’s disease management program, as well as vendor oversight.
• Works with cross disciplinary team to coordinate and perform medical informatics analysis for all lines of business.  Oversees the collection, analysis, reporting and trending of data relative to health- related baselines, outcomes and return on investment of intervention activities.
• Manages budgets and staffing for assigned area. Ensures there is knowledge of learning and training from all improvement projects, processes and initiatives to provide shared reporting with ODM and contracted Providers.
• Manages and coordinates the health plan’s clinical quality improvement (CQI) activities among functional areas, monitors the progress of CQI activities against the annual CQI work plan and ensures potential quality of care issues are investigated and resolved.
• Communicates and monitors quality initiatives, as well as promoting culture changes that support an environment of quality.
• Performs other duties as assigned.

Qualifications

Education and Experience:

• Bachelor’s degree in Nursing, Healthcare Administration or related healthcare field required. Master’s degree preferred.
• 8 years progressive clinical and managed care experience in quality management and quality improvement, 5 years of which are in management and/or leadership capacity driving large scale projects/programs companywide.
• Significant experience in government programs (Medicare/Medicaid).

Professional Certification(s):

• Registered Nurse actively licensed in the State of Ohio, preferred
• Certification in one of the following:

 
 

• Certified Professional in Health Care Quality by the National Association for Healthcare Quality (NAHO)
• Certified QI Associate by American Society for Quality, and /or Certified in Health Care Quality and Management (CHCQM) by the American Board of Quality Assurance and Utilization Review Providers prior to employment or within six months of date of hire.

Technical Skills and Knowledge:

• Comprehensive knowledge of managed care tools, components, delivery systems and models; 
• Comprehesive knowledge of evidenced-based clinical care management, regulatory/accreditation standards and operational management procedures, clinical quality programs, government programs.
• Advanced oral, written, and interpersonnal communication skills with the ability to present to various audiences includes executive management.
• Knowledge of and the ability to develop and manage Medicaid program improvement projects, and processes to identify and address health disparities.
• Knowledge of quality improvement applications, tools and methods.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That’s why we offer an exceptional package that includes:

A Great Place to Work:

• Top Workplace in Northeast Ohio. Year after year we’ve received this recognition!
• On-site wellness center at most locations. Enjoy personal trainers, towel service, locker room, weight room, elliptical machines, and a variety of classes!
• On-site cafeteria serving hot breakfast and lunch, at most locations. Choices ranging from salad bar, made to order, hot and cold sandwiches, or a variety of entrees cooked fresh daily. Convenience store at most locations
• Employee discount program. Discounts at many places in and around town, just for being a Medical Mutual team member
• Business Casual attire

Excellent Benefits and Compensation:

• Competitive compensation plans
• Employee bonus program
• 401(k) with company match and an additional company contribution
• Excellent medical, dental, vision, and disability insurance

An Investment in You:

• Career development programs and classes
• Mentoring and coaching to help you advance
• Education reimbursement up to $5K per year

About Medical Mutual:

We strive to create peace of mind. Our customers can trust us to do things right and to help them get value from their health plan. We’re the largest health insurer in Ohio and for over 85 years, we’ve been serving our members and the Ohio communities where they live and work. Medical Mutual is a Top Place to Work in Northeast Ohio with exceptional career opportunities that offer challenge, growth and a great work/life balance. We want talented, innovative, and driven people to help us continue to be the best health insurance choice of Ohioans and help make Ohio the best it can be! Our headquarter building is located in the heart of downtown Cleveland and we have multiple offices throughout the state. Join us at one near you!

 
 

At Medical Mutual and its family of companies we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.

 
 

Clipped from: https://www.ziprecruiter.com/c/Medical-Mutual/Job/Director,-Clinical-Quality-Improvement-Medicaid/-in-Cleveland,OH?jid=406fdb245a0ce7fe&utm_campaign=google_jobs_apply&utm_medium=organic&utm_source=google_jobs_apply

 
 

 
 

Employment Type:

Full-time

Exempt or Non-Exempt:
Exempt

Job Summary:
 

Focused on HMSA’s Government Programs plans (e.g. Medicare and Medicaid-related), extracts data from multiple internal and external sources, provides statistical, financial, and business analysis to help HMSA manage the Medicare and Medicaid line of business financial performance and cost of health care, such as evaluating quality improvement initiatives, the effectiveness of various health programs, population health improvements, and clinical outcomes that initiate action or change.

Functions independently and serve as a senior level subject matter expert on the performance management functions for HMSA’s Government Program plans. Leads projects and represents the department on organizational projects.

Minimum Qualifications:

• Bachelor’s degree and four (4) years of related experience, or an equivalent combination of education and related work experience.
• Strong working knowledge of the techniques used to present statistical data.
• Effective analytical skills to evaluate data reliability, determine appropriate statistical models, correlate factors and organize data.
• Strong written and verbal communication skills.
• Organization and time management skills to work on multiple projects simultaneously and meet project deadlines.
• Basic knowledge of Microsoft Office applications. Including but not limited to Word, Excel, Outlook, and Power Point.

Duties and Responsibilities:

Research and Analysis:

• Conduct research, uses algorithms and specific skills in quality improvement, medical statistics and financing and applies sound knowledge of statistical theory and its application to research methodology.
• Reconciles internal information related to risk scores and anticipated revenue, membership, and classification of HMSA’s membership with CMS and QUEST information, either directly or through oversight of other departments, to assure that HMSA is receiving proper credit and payment for all Government-related plans.
• Primarily responsible for data analysis from various sources to provide statistical data for financial modeling, quality improvement research and reporting for physicians and providing actionable data and reports to improve cost and quality of care. Ensures feasibility and evaluates reliability of data source information, conducts analysis of statistical data sets, interprets statistics and identifies significant relationships, and organizes results into a compatible and useful format to prepare conclusions and forecasts based on data summaries.
• Researches and identifies opportunities in performance of line of business such as RAPS/EDPS data submission accuracy, reducing error rates in LIS, MSP, or other indicators that impact premiums and develops action plans for recommendation.
• Analyzes claims data information and utilizes predictive algorithms to develop recommendations regarding interventions for health services programs.
• Develops reporting tools and maintains various database programs, including financial and clinical data, to analyze, track, review and support a variety of medical management activities.

Applications and Data Analysis:

• Responsible for design, analysis, development, integration, maintenance and support of specific internal applications related to data analysis.
• Completion of existing risk adjustment processes, workflows and programs.
• Takes primary lead on testing efforts of new or modified applications for department.
• Analyzes existing applications and/or designs new computing services or systems to complete data analyses and reporting required to meet changing goals.
• Evaluate system options, make recommendations, provides input and technical guidance. Develops necessary project plans for implementation to lead and coordinate problem tracking, resolution, and verification testing, as needed.

Project Management and Administration:

• Provides leadership to critical technology projects to assure data analysis and reporting capabilities are incorporated and available.
• Utilize project management techniques to document and coordinate activities to ensure deliverables are met.
• Perform cost/benefit analysis that supports business operations and project management. Assist to define solutions that support business flows through use of workflow design/redesign.
• Monitor, evaluate, interpret and disseminate program requirements related to risk adjustment activities. Ensure activities are conducted in accordance with applicable standards, line of business controls and requirements. Develop methods to improve daily operations and practice standards.
• Collaborates and works with external customers and clients (primarily physicians and clinic administrators) to evaluate business needs.

Reports and Presentations:

• Analyze/create derived results, translates data, and creates analytical presentations using tables, graphs, charts, written report or other methods.
• Produces written project and study reports in a structured and informative manner.
• Ensure reports and presentations are accurate, concise, clearly stated and appropriate for internal and external audiences and all levels of staff.
• Collaborates and works with external customers and clients (primarily physicians and clinic administrators) to evaluate business needs.
• Design reports to deliver data and information that will address and improve business needs.

 
 

Other Duties/Functions:

• Perform all other miscellaneous responsibilities and duties as assigned or directed.

Clipped from: https://www.glassdoor.com/job-listing/senior-business-analyst-medicare-medicaid-financial-performance-hmsa-JV_IC1140656_KO0,63_KE64,68.htm?jl=3647558694&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Job details

The incumbent will identify business needs, solutions, write processes and procedures, and measure the effectiveness of solutions post-implementation for a wide variety of policy and program changes. The incumbent will be a strong team contributor, have the ability to lead and manage small projects and project teams. We are searching for an individual with exceptional business analysis skills including process flow development, requirements delivery, critical thinking, interpersonal skills and systems-thinking competencies.

Key Responsibilities

• Research and analyze business issues and operational changes
• Facilitate workgroups and business resources to define business needs, coordinate the gathering and reconciliation of detailed business requirements for system development
• Document business process work flows across the division, in coordination with project stakeholders, data and technology support teams
• Analyze issues, identify solutions and develop documentation to meet needs of business teams and programs
• Support project management efforts as assigned
• Create documentation to support business operations
• Maintain an electronic repository for written documentation including current and future business process flows, business requirements, user guides, and others as assigned
• Utilize and/or develop standardized tools that can be used to assess needs, document process flows, and contribute to training and communications to support project goals and business changes

Qualifications

• Good knowledge of project management
• Good knowledge of organizational/business analysis and evaluation
• Good knowledge of process improvement methodology
• Experience developing business process flows, business requirements and process documentation. Gained by at least one year of work experience where business process analysis was a primary responsibility and utilized analytical and facilitation skills and software tools to develop business process flows, requirements and process documentation.
• Certification of Competency in Business Analysis (CCBA/CBAP) status or certification. Gained by meeting certification requirements from the International Institute of Business Analysis (IIBA), Project Management Institute (PMI), Six Sigma certification or other certifying body.
• Experience using Smartsheets, SharePoint, Visio and PowerPoint. Gained by at least one year of work experience using the software.
• Experience with process engineering methodologies and/or operational processes. Gained by a Bachelor’s or Master’s degree in Engineering or Business Administration.
• Experience in change management. Gained by at least one year of work experience where leading change utilizing change management principles was the primary responsibility.

 

Clipped from: https://www.lerip.com/us/job/business-analyst-medicaid-project-management-office-state-of-idaho-boise-idaho/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

We are seeking a Medicaid Business Analyst to join our team. We are in need of a strong business analyst with experience in a large Medicaid enterprise environment. This role will focus on the implementation of a large data warehouse environment initially using Medicaid data. This Business Analyst will work closely with both the Database Administration team and our development teams. Primary Responsibilities Work closely with customers to gather business requirements and translate requirements clearly into accurate specifications for the configuration of large data warehouse systems Use Application Lifecycle Management (ALM) tools such as IBM Rational to trace development and deliverables through the system development lifecycle Research MMIS managed care and fee for service policy to ensure system specifications are accurate to policy. Review deliverables and enforce the approval process of deliverables to ensure that quality assurance processes are strictly followed Proven ability to work with customers, DBAs, ETL programmers, Business intelligence architects, and PMO staff in a collaborative manner. Demonstrated knowledge of the use of Application Lifecycle Management tools (such as Rational, HP, DevSuite). Excellent communication and presentation skills with the ability to communicate complex technical concepts to business users in a clear and concise manner. Thorough understanding ICD-9, ICD-10, CPT-4, NDC and other medical coding standards Required Qualifications: Business Intelligence experience with at least one of the following tools: Cognos, Business Objects, MS Analysis Services, Hyperion, Oracle, Tableau 5+ years of experience working with Medicaid or health plan programs and data. Extensive knowledge of Federal and State healthcare programs (i.e., Medicaid, CHIP) and related eligibility/enrollment principles, and claims data Experience contributing to and managing the planning and execution activities for the following SDLC phases: Systems analysis and requirements definition Systems design System Testing User Acceptance Testing Maintenance and operation support Strong knowledge of SQL Experience with data analysis techniques, data modeling and data management tools (e.g., MS Excel, SQL language, relational databases) Preferred Qualifications: Understanding of ETL tools including Informatica and business intelligence tools including Cognos Experience with the IBM Rational Suite including Rational Team Center Understanding of relational & dimensional modeling Understanding of HIPAA privacy & security rules Knowledge of Medicaid payment policy and MMIS data Knowledge of Agile and waterfall development techniques Optum is a diversified health services and innovation company where data, technology, people and action combine to make great things happen every day. Join us. Learn more about how you can start doing your life’s best work.(sm) Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Job Keywords: GovtConsulting Job Title: Medicaid Data Warehouse Business Analyst – Richmond, VA Shift: Day Job Travel: No Business: Optum State Govt Solutions Family: Information Technology Telecommuter Position: No Job Level: Individual Contributor Overtime Status: Exempt Posted Date: 9/7/2018 City: Richmond State: VA Country: United States Department: Optum State Govt Data Warehsng

Clipped from: https://richmond-va.geebo.com/jobs-online/view/id/678250565-medicaid-data-warehouse-business-/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Dedicated Tech Services, Inc. (DTS) is an award-winning IT consulting firm based in Columbus, OH. We now have an opening for a Business Systems Analyst with Integrated Eligibility Systems (IES) (Medicaid) experience.

s and those authorized to work in the US are encouraged to apply. We are unable to sponsor at this time.

Direct applicants only, no corp-to-corp candidates, third parties, or agencies, please.

Required Skills and Experience:

• 15 years’ experience as a Business Systems Analyst
• Experience with Integrated Eligibility System (IES) (Medicaid).
• State Medicaid experience
• Experience conducting requirements analysis and documenting requirements to implement new functionality and changes, including:

 
 

• Identifying and documenting As-Is and To-Be requirements and design using the prescribed, agreed-upon business analysis methodology;
• Toolkit and tolls including but not limited to process flows, functional design documents, Use Cases, requirements traceability matrixes, and UI specifications and mockups.

• Experience working closely with project managers and relevant stakeholders, including
• Experience producing work products that reflect and ensure system planning, design, and delivery are in line with business needs.
• Experience leading peer reviews of the design documentation and support in internal review processes.
• Experience collaborating closely with developers to implement the requirements, participate in system testing and assist in responding to queries and clarifications from the QA and UAT teams.
• Experience assisting with the analysis of bug fixes/issues, with demonstrated ability to lead small groups of IT and business staff for troubleshooting, problem resolution and brainstorming for available solutions.
• Must be able to work remotely initially and then work on site at the client when pandemic conditions allow.
• Must have a personal internet connection.

Desired Skills and Experience:

• 4 year college degree
• Certified IIBA and CBAP Business Analyst

Job Description:

We are hiring an experienced Business Systems Analyst with IES experience to work for us as a direct, W2 salaried or hourly employee, and the selected candidate will work on an engagement for our client. You will:

• Conduct requirements analysis of the state systems and document requirements to assist in implementation of new functionality and changes, including: identify and document as-is and to-be requirements and design using the prescribed business analysis methodology, processes, toolkit, and tools including but not limited to process flows, functional design documents, use cases, requirements traceability matrix, user interface specifications and mockups.
• Work closely with project manager and relevant stakeholders, including state and county subject matter experts, users, and executive teams to elicit requirements.
• Produce work products that reflect and ensure system planning, design, and delivery are in line with business needs.
• Lead peer reviews of the design documentation and support in internal review processes.
• Collaborate closely with developers to implement the requirements, participate in system testing and assist in responding to queries and clarifications from the QA and UAT teams.
• Assist with the analysis of bug fixes/issues, with demonstrate ability to lead small groups of IT and business staff for troubleshooting, problem resolution and brainstorming for available solutions.
• Understand and adhere to project timelines and priorities.
• Work with blended client and vendor resources.

Why DTS?

We’re inclusive; celebrate your role, grow in your position, feel the freedom to explore, trust the commitment, experience the opportunity. We’re growing, and we need great people to grow with us! Simply put, we’re enabled to hire the best. Our Project Delivery, Enterprise Support, Information Security, and Development Services practices are led by DTS consultants who help select our employees and then guide them. What’s in it for you? A collaborative, supportive environment where high standards, quality, and excellence are the norm.

Why Columbus?

It has an exciting Information Technology market, a reasonable cost of living, a low unemployment rate, and a strong quality of life! It’s the 14th-largest city in the United States and is home to fifteen (15) Fortune 1000 companies which are all very dependent on IT.

Our Vision:

By building a clear sense of purpose and strong relationships within Dedicated Tech Services, the staff and leadership team can then aspire to be the technology service provider whose quality services set the standard by which others are measured and that our clients ask for by name.

Our Benefits:

In addition to the opportunity to work for a caring and supportive company, DTS offers health, vision, and dental insurance, a 401K plan, bonus options, and more! Please visit our web site for more information: https://www.dtsdelivers.com

Dedicated Tech Services, Inc. is an Equal Opportunity Employer

 
 

Clipped from: https://www.dice.com/jobs/detail/Business-Systems-Analyst-with-Integrated-Eligibility-Systems-%28IES%29-%28Medicaid%29-experience-Dedicated-Tech-Services%2C-Inc.-%28DTS%29-Columbus-OH-43085/90968525/7013?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

MetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

Reporting to the Director, Medicaid the Operations Analyst will play a critical role in supporting operational excellence and regulatory compliance across all Medicaid products. The analyst will provide analytical and project management support to the Director to ensure prompt follow-up and timely completion of projects.

 
 

Clipped from: https://www.jobs2careers.com/r/job/14985219422?aff_id=5802&dest=https%3A%2F%2Fwww.jobs2careers.com%2Fclick.php%3Fjid%3D39b0e554ddcd57e9a9660b124%26cri%3D0%26js%3D0%26pv%3D1%26is_adv_only%3D1&click_time=2021-02-01+09%3A27%3A31&tlr_sid=dde17dfa9fafa3d7

 
 

 

 

 
 

KPMG is currently seeking a Manager in State and Local Government for our Consulting practice.

Responsibilities:

Support and deliver large, complex public services and state/local government engagements that identify, design, and implement creative business and technology services for state/local government clients

Engage projects as a Business Analyst Subject Matter Professional

Lead your team to produce related project deliverables on a scheduled basis and also produce project deliverables yourself

Manage the day-to-day deliverables with assigned team members

Develop and execute methodologies and solutions specific to the public sector and state/local government industry

Qualifications:

Minimum of five years of experience in the Health and Human Services Medicaid solution delivery market, working for a commercial COTS solution provider or consulting organization with a minimum of five years of experience managing large, complex technology projects on the scale of a State Medicaid MMIS solution

Bachelors degree from an accredited college/university in technical sciences or information systems

Must have served in a team lead role on at least (1) MMIS implementation and (1) MMIS M&O engagement in a Functional Requirement teams and demonstrated experience as a team lead of 5-7 staff, including staff from diverse organizations to successfully implement and operate technology-based solutions

Hands-on experience with the Center for Medicare and Medicaid Services (CMS) Medicaid Information Technology Architecture (MITA), Medicaid Certification Lifecycle, associated toolkit and CMS checklists

Business Analyst professionals should have 4+ years of demonstrated Medicaid knowledge with MMIS modules including claims processing, finance, pharmacy, provider, TPL, managed care

Capable of presenting Medicaid topics to large, varied audiences in either written or verbal presentation format and experience in working on customer proposals or deal capture teams in the State Medicaid market

 
 

Clipped from: https://wtaelocaljobs.com/jobs/manager-state-and-local-business-analyst-harrisburg-pennsylvania/222725592-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Resp & Qualifications Lead IT Business Analyst, Medicaid Solutions We are looking for a talented Lead Technical Business Analyst to join the revolution in health care IT We are working on “the big picture” of the future of health care information technology and what we do touches the lives of millions of people. Today, we are looking for a multi-talented Lead Business/Systems Analyst who wants to make a difference; be change-maker, while working together to build a leaner approach to business solutions through technology and really make an impact on our Medicaid Solutions team and our success. At CareFirst BlueCross BlueShield, you will have the opportunity to influence the direction of health care by participating at an expert-level with the feasibility of the most complex enhancements, automations and implementations review, analysis, and evaluation of current and future business processes. Explore alternative business solutions – is liaison to business/IT/Shared Services to explain choices and implications – works closely with system analyst to help create POCs and alternative solutions to create, maintain and enhance business value. Develop solutions that solve the most complex technical and/or business issues. Ideally, you will bring experience managing and facilitating JAD sessions, expertly gather and prioritize systems requirements and proactively identify various opportunities and enhancements with specific healthcare payer-side authorization, claims adjudication, etc. while independently leading or participate in all phases of the software development life cycle, with focus on defining the underlying business needs, documenting those needs, validating conceptual systems designs, and assuring delivery quality through comprehensive testing and training. PRINCIPAL ACCOUNTABILITIES: * Lead and participate at an expert-level with the feasibility of the most complex enhancements, automations and implementations review, analysis, and evaluation of current and future business processes.
* Explore alternative business solutions – is liaison to business/IT/Shared Services to explain choices and implications – works closely with system analyst to help create POCs and alternative solutions to create, maintain and enhance business value.
* Develop solutions that solve the most complex technical and/or business issues.
* Proactively identifies opportunities and enhancements. Independently lead or participate in all phases of the software development life cycle, with focus on defining the underlying business needs, documenting those needs, validating conceptual systems designs, and assuring delivery quality through comprehensive testing and training.
* Analyze define and interpret business needs and issues by gathering, analyzing, documenting, and validating the Business area(s) and user(s) technical (functional/non-functional) requirements.
* Create PRD (Project Requirements Document) for most complex enhancements, automations and implementations including defining Business, User and functional and non-functional requirements needed for approval by Business and for use by Design, Development and Testing teams.
* Create Requirements Management Plan to define, organize and schedule requirements management and development activities. Lead requirements analysis and verification sessions. Produces Requirements Traceability Matrix (RTM) and RTM gap analysis reports.
* Track and manage open issues and plan for resolution. Troubleshoot systems problems, identify cause of problems, work with appropriate group to correct problem. Maintain communications with technical counterparts to guide the issues to cross-functional resolution and adopt best practices and ensure integration of specific application architecture into overall enterprise technology strategy.
* Lead testing efforts by defining, developing, and implementing practices and procedures for complete end user test plans. Ensures all tests are conducted and documented according to standards. Identifies and documents system deficiencies and recommends solutions.
* Responsible for overall success of testing, including results verification and release. Coordinates groups of end users who test, evaluate, and validate new functions and applications and identify issues in software or services to ensure continuing operational quality by documenting fixes and enhancements. Providing guidance and training to application end users. Provides ongoing assistance to software developers and testers to resolve defects during the testing process. Leads development sessions and design reviews to ensure design meets user requirements.
* Reviews, edits, analyze and create detailed documentation of business systems and user needs. Responsible for writing all documentation in clear and well-organized manner including SOPs and training manuals.
* Use project management techniques to establish roles and responsibilities, monitor project and request status and workload, and ensure deliverables of high quality, effectiveness, and timeliness and manage assigned enhancements, automations, and implementations from concept through implementation. Creates, develops, and maintains project schedules for key deliverables by developing project plan, monitoring milestone completion, and coordinating project progress. Develops key project deliverables including requirements specifications, use cases, system test cases, training and documentation and user manuals for the most complex enhancements, automations, and implementations. Manages the sequencing of releases to meet business needs. ADDITIONAL KNOWLEADGE, ABILITIES & SKILLS: * Relevant business and systems subject matter expertise with the ability to work independently and as part of a team ad have excellent interpersonal skills including the ability to build consensus and agreement and bring resolution to contentious issues and entrenched interests.
* Have proven ability to lead problem-solving discussions with attention to detail and excellent analytical and problem-solving skills, advanced written and verbal communication skills, excellent organizational skills, and ability to set priorities and handle multiple projects concurrently.
* High level of analytical and problem-solving skills with extensive PC skills including Microsoft office software such as Word, Excel, VISIO and Power Point and experience in accurately modeling requirements using at least one if not more of the following: Functional Decomposition, Data Flow Diagrams, User Context Diagrams, Activity Diagrams, Decision Needs, Workflow modeling, Use Cases, Use Case Model Survey and Use Case Specification, Process Modeling, Prototyping
* Demonstrated leadership skills.
* Experience with coaching, mentoring, and providing feedback to associates as well as leading small teams of junior analysts. BASIC QUALIFICATIONS: * This position requires a bachelor’s degree in Information Technology, Computer Science or Business or relevant work experience in business analysis, systems analysis and/or testing background and 6+ years of direct Business Analyst experience
* Experience in business process analysis, Workflow, task analysis, user acceptance testing and requirements analysis with proven ability to elicit, document, analyze and verify requirements.
* Strong experience with user acceptance testing concepts, proven ability to work well as a team, demonstrated ability to lead problem solving business/technology teams and projects, have technical writing experience and training experience.
* Minimum of 4 years of demonstrated successful use of SDLC methodology or demonstrated knowledge of business processes related to the business area supporting and must demonstrate understanding of industry standard Business Analysis Best Practices. PREFERRED QUALIFICATIONS: * Knowledge of organization and operations of the business area supporting and understands basic Internet and client/server architectures.
* BA certification with experience using Requirements Management tools, experience in the healthcare insurance industry, especially BCBS plans.
* Experience with software testing, test management and defect tracking tools. Equal Employment Opportunity CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. Hire Range Disclaimer Actual salary will be based on relevant job experience and work history. Where To Apply Please visit our website to apply: ~~~/careers Closing Date Please apply before: 1/10/2021 Federal Disc/Physical Demand Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. PHYSICAL DEMANDS: The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. Sponsorship in US Must be eligible to work in the U.S. without Sponsorship

Monday, February 1, 2021

8:27 AM

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