EXPERIENCED BUSINESS ANALYST - CLAIMS CONFIGURATION - QNXT
Company: Gainwell Technologies LLC
Location: Dallas
Posted on: October 16, 2024
Job Description:
Be part of a team that unleashes the power of leading-edge
technologies to help improve the health and well-being of those
most vulnerable in our country and communities. Working at Gainwell
carries its rewards. You'll have an incredible opportunity to grow
your career in a company that values work flexibility, learning,
and career development. You'll add to your technical credentials
and certifications while enjoying a generous, flexible vacation
policy and educational assistance. We also have comprehensive
leadership and technical development academies to help build your
skills and capabilities. SummaryAs a Experienced Business Analyst -
Claims Configuration - QNXT at Gainwell, you can contribute your
skills as we harness the power of technology to help our clients
improve the health and well-being of the members they serve - a
community's most vulnerable. Connect your passion with purpose,
teaming with people who thrive on finding innovative solutions to
some of healthcare's biggest challenges. Your primary
responsibility is to analyze and document business processes,
gather and define requirements, and collaborate with stakeholders
to ensure the successful implementation of solutions that meet the
unique challenges and requirements of the healthcare industry. The
successful candidate will be an intellectually curious,
self-directed individual with excellent organizational skills and
attention to detail. This role is highly collaborative in nature
providing support for IT and business teams. Performs complex
analyses of State Medicaid Policies, and Legacy System business
rules from data extracts. Here are the details on this position.
Your role in our missionPlay a critical part in ensuring Gainwell
is meeting our clients' objectives in important areas
- Analyzes client requests and applies advanced subject matter
knowledge to solve complex business issues and is regarded as a
subject matter expert
- Adheres to and supports Configuration team approach and other
configuration principles, methodologies, and practices
- Ensures communication among all key stakeholders
- Exercises significant independent judgment within broadly
defined policies and practices to determine best method for
accomplishing work and achieving objectives
- May provide mentoring and guidance to lower-level
employees
- Works closely with the Configuration team to analyze and
determine if business rules cannot be configured within the system.
If cannot be configured, communicates the rules via a Stored
Procedure Specification Document so a Custom Stored Procedure can
be developed
- Creates test cases from functional requirements, executing test
cases, and documenting results. Participates in technical reviews
and inspections to verify 'intent of change' is carried out through
the entire project
- Provide accurate status and time reporting for project related
tasks ....your role continued
- Ability to read Custom Stored procedures
- Medicaid Systems work experience
- Ability to exercise discretion and independent judgment
- Analyzes configuration data and structure to isolate
defects
- Research and define solutions for new configuration,
legislation, or client rules
- Creates proof of concept testing for new business processes or
outcome requests
- Creates and presents solution, proof of concept, or testing
results to customer
- Completes configuration within schedule timelines and
configuration best practices What we're looking for
- Six or more years of business analysis experience
- Ability to create and maintain highest levels of
confidentiality when dealing with proprietary or private
information
- Four or more years' experience configuring in QNXT:
- Contracts/benefits
- Claims Pricing methodologies
- System data points needed for successful X12 transactions,
Claim Adjustment Reason Codes and Remittance Advice Code
- Contracts for provider services, benefits for member coverage,
fee schedules, capitation, and claim editing enforcement
- Experience working with Medicaid/MMIS systems
- Experience processing Medicaid claims and ability to
troubleshoot adjudication results
- Understands Medicaid Program structure in carriers, programs,
benefit plans, policy, policy plans, sponsor, and orgpolicies
- Understands Provider (Contract and Pricing) data including but
not limited to provider type, specialty, taxonomy, enrollment
impacts, service locations, certifications and licensing,
affiliations, and reimbursement impacts
- Understands Member data including but not limited to aid
categories, coverage codes, benefit packages, restrictions,
limitations, prior authorizations, programs, and primary care
providers
- Experience with Configuration Implementation Build &
Maintenance Technical skills
- Bachelor's degree or equivalent combination of education and
experience. Bachelor's degree in business administration,
information systems, or related field preferred
- Highly proficient in the use of Microsoft Office Products
(PowerPoint, Excel, Word. Visio, Outlook)
- Preferred experience working with HP Application Lifecycle
Management (ALM)
- Experience writing SQL queries for data analysis
- Preferred experience includes DDI (Design, Development, and
Implementation) and operations phases
- Experience working with complex systems at a detailed
level
- Understands relational database concepts and schemas
- Demonstrated aptitude for learning new technologies and keeping
current with industry best practices Soft skillsCommunication:
- Openly and actively communicates information and takes
initiative to communicate extensively.
- Strong written and verbal communication skills to ensure
clarity
- Presentation skills to present to management and customers Team
and Goal oriented:
- Experience working in a virtual team environment performing
self-directed tasks.
- Ability to work in a collaborative team environment to achieve
a common goal
- Interpersonal skills to interact with customers and team
members Analytical and problem-solving:
- Ability to exercise sound judgment and make decisions in a
manner consistent with the essential job functions.
- Adaptable to changing priorities
- Handles difficult situations diplomatically Multitasking and
reliability:
- Regular and reliable attendance is an essential function of
this position
- Ability to manage multiple priorities ensuring deadlines are
achieved
- Ability to work in a remote environment, self-directed with
minimal supervision
- Ability to multi-task and maintain organization in a fast-paced
environment What you should expect in this role
- Fully remote options from most US locations and
territories
- Video cameras must be used during all interviews, as well as
during the initial week of orientation
- The deadline to submit applications for this posting is October
22, 2024 #LI-HC1 #LI-Medicaid Claims Configuration #LI-QNXT The pay
range for this position is $69,400.00 - $99,200.00 per year,
however, the base pay offered may vary depending on geographic
region, internal equity, job-related knowledge, skills, and
experience among other factors. Put your passion to work at
Gainwell. You'll have the opportunity to grow your career in a
company that values work flexibility, learning, and career
development. All salaried, full-time candidates are eligible for
our generous, flexible vacation policy, a 401(k) employer match,
comprehensive health benefits , and educational assistance. We also
have a variety of leadership and technical development academies to
help build your skills and capabilities. We believe nothing is
impossible when you bring together people who care deeply about
making healthcare work better for everyone. Build your career with
Gainwell, an industry leader. You'll be joining a company where
collaboration, innovation, and inclusion fuel our growth. Learn
more about Gainwell at our company website and visit our Careers
site for all available job role openings. Gainwell Technologies is
committed to a diverse, equitable, and inclusive workplace. We are
proud to be an Equal Opportunity Employer, where all qualified
applicants will receive consideration for employment without regard
to race, religion, color, national origin, gender (including
pregnancy, childbirth, or related medical condition), sexual
orientation, gender identity, gender expression, age, status as a
protected veteran, status as an individual with a disability, or
other applicable legally protected characteristics. We celebrate
diversity and are dedicated to creating an inclusive environment
for all employees.
Keywords: Gainwell Technologies LLC, North Richland Hills , EXPERIENCED BUSINESS ANALYST - CLAIMS CONFIGURATION - QNXT, Professions , Dallas, Texas
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