Business Analyst (Claims), Senior

Acentra Health is dedicated to empowering better health outcomes through technology and clinical expertise. They are seeking a Senior Business Analyst (Claims) to lead the design and functionality of solutions involving complex information systems, ensuring alignment with business requirements and strategic vision.

Responsibilities:

• Elicit requirements working with customer and stakeholders
• Demonstrates in-depth knowledge of business and technical solutioning relates to Core Claims to ensure high quality
• Works with customers on presenting technical solutions for complex business functionalities
• Possesses unwavering commitment to customer service and operational excellence
• Provides customer support through leading client demos and presentations
• Prioritizes and schedules work assignments based on the project plan, handling multiple tasks across project phases
• Creates and modifies Business Process Models
• Understands the overall system architecture and cross-functional integration
• Demonstrates in-depth knowledge of business analysis relates to Provider Enrollment, Maintenance and Screening to ensure high quality
• Possesses in-depth knowledge and is well-versed in multiple functions or capabilities
• Uses cases, workflow diagrams, and gap analysis to create and modify requirements documents and design specifications
• Analyzes user requirements and client business needs, leveraging expert opinion and expertise
• Acts as the requirements subject matter expert and supports requirements change management
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules

Requirements:

• Bachelor's degree or equivalent experience in lieu of a degree
• Minimum 5+ years of business analysis experience in Healthcare Domain knowledge with strong knowledge on Medicare / Medicaid Management Information System around Core Claims and/or Provider Management and Enrollment System experience
• The Company acknowledges that practical, hands-on experience can provide skills and competencies equivalent to formal education. As such, in cases where a Bachelor's degree is typically required, the company will accept a minimum of six (6) years of directly relevant professional experience in lieu of a degree. In instances where the candidates has an Associate's degree, the company will accept a minimum of three (3) years of directly relevant professional experience in lieu of the Bachelor's degree
• Minimum 5 years of experience on large complex project and domain knowledge of Medicare healthcare vertical
• Strong knowledge in Medicare policies and guidelines
• Strong knowledge in claims adjudication and validations
• Strong knowledge in Medicare Reimbursement methodologies
• Excellent Business Analysis Process (SDLC, documentation procedures) experience
• Excellent customer relation skills including presentation and meeting facilitation
• Experience facilitating and running customer facing requirements and design sessions
• Excellent requirements elicitation and validation skill
• Strong knowledge and proficiency in SQL, plus high-level of technical and database knowledge