Healthcare Business Analyst

Sogeti is a company seeking a Healthcare Business Analyst to support their projects in the healthcare domain. The role involves creating and maintaining business requirements documents, facilitating reviews, and assisting project managers with transition plans and operations support.

Responsibilities:

• Create/maintain Business Requirements Document (BRD)
• Create/Maintain Requirements Traceability Matrix (RTM)
• Develop supporting diagrams (process flows, context diagram)
• Develop business, functional & non-functional requirements
• Facilitate Business Owner review
• Build UAT scenarios
• Provide input on client University project training plan
• Provide input on project status report
• Provide input on project change control
• Assist Project Manager w/transition plan activities
• Escalate issues/risks to Lead BA (if applicable) & Project Manager
• Assist Business Owner with documenting current or future state process flows
• Assist Project Manager to create operations & support plan
• Obtain approvals on deliverables
• Assist the project team in estimating the impact of change requests on timelines, budgets, resources and project scope
• Develop requirements management plan (RMP)
• Create/maintain Business Requirements Document (BRD) as necessary
• Experience in using Azure Devops for product management lifecycle
• Collaborate w/Integration Test Lead to create UAT scenarios
• Assist Program Manager to create operations & support plan
• Provide input on program status report
• Provide input on program change control
• Assist Program Manager w/transition plan activities
• Escalate issues/risks to Program Manager
• Mentor other BA’s in proper processes and standards

Requirements:

• Expertise in Health Plan's Provider space -specifically Provider Information and Provider Data
• Provider Demographics, Credentialing, Contracting, Fee schedule, and Hierarchy (provider, group, systems, etc), Provider Networking
• Provider vendor onboarding processes
• Strong E2E background in Health Plan in Clinical space
• Knowledge of Clinical Policy
• Knowledge of HealthEdge's Guiding Care system
• Working with Electronic Health Records (EHRs)
• Care Management Experience (Assessments, Statisfication, Letters)
• Utilization Management (Channels, Codes, Turn Around Times, Policies), Prior auth
• Process assessment for Clinical Vendor onboarding/extensions
• Healthcare plan enrollments and EDI files
• Pharmacy healthcare processes, Pharmacy operations and Data
• Understanding of how Pharmacy claims are paid. Knowledge of Formularies, files exchange process with PBM's
• Claims adjudication process. Understanding of claims data and systems (FACETS)
• Understanding of claims billing practices
• Understanding of compliance and regulatory reporting and CMS guidelines
• Research reporting related requirements in state and federal contracts and regulations
• Understanding of Program Integrity function and Reporting
• Define processes for documentation of reporting requirements, sharing of reporting requirements with the larger team
• Understanding of reporting databases
• Understanding of Healthcare equity
• Social Determinants of Health and processes with Community Based Org
• Vendor discontinuation processes
• Understanding of Health Information Exchange function
• Knowledge of Call Center Operations
• Understanding of HEDIS, Quality Management
• Knowledge of Value Based Reimbursement and trends
• Understanding of Electronic Visit Verification process
• Facilitate requirements elicitation sessions
• experience in using Azure Devops for product management lifecycle