Senior Business Analyst - Healthcare Claims - MMIS

Gainwell Technologies is seeking a Senior Business Analyst - Healthcare Claims - MMIS to contribute skills in harnessing technology for healthcare improvement. The role involves preparing for client meetings, ensuring procedural manuals are updated, and collaborating with clients on change requests and system updates.

Responsibilities:

• Ensure that items are prepared for client meetings
• Ensure Operating Procedure Manuals are updated as required
• Work with the client on change requests, publications and claim adjustments/reprocessing
• Research, identify, and specify solutions to problems
• Document updates for all reference updates/changes
• Work with the systems team on any assigned system changes, meeting required timelines
• Assist with quarterly and annual CPT, HCPCS and diagnosis code updates in the system, ensuring rules are correct and working on edit and audit configuration

Requirements:

• 5+ years as a Business Analyst with healthcare claims experience required
• Must be proficient in Excel
• Proficient in CPT, HCPCS and ICD-10 coding
• Must work collaboratively in a team environment in making changes to the reference system for CPT, HCPCS and ICD-10 coding updates and benefit plan coverage
• Build relationships and working collaboratively; effective verbal/ written communication
• Ability to assist/create manual documentation as well as provider notifications
• Certified coder is a plus