[Remote] Claims Business Analyst (Healthcare Payer)

Note: The job is a remote job and is open to candidates in USA. Group Nine LLC is a healthcare payer company seeking a Business Analyst II for a long-term contract position. The role involves configuring accounts receivable and payable processes, managing financial systems, and collaborating with clients and IT teams to gather requirements and implement solutions.ResponsibilitiesConfigure accounts receivable processing tasks including setting up accounts receivable, developing reports specifications to on accounts receivables. Assess client AR business operations and configure or develop new processes for configuring the financial system. Knowledge in the following business processesExperience in Provider Recoupment in a Payer setupManage RecoveriesManage AR fundsConfigure accounts payable processing tasks including set up accounts payable, developing reports specifications for accounts payable. Discuss with client to understand their accounts payable operations and configure financial system according to the client processes. Knowledge in the following business processesManage contractor paymentsManage AP disbursementFamiliar with 1099 ProcessFiscal ManagementBudget ManagementManage FundsCompare current reports (accounts receivable, accounts payable, cash receipts and other payment related etc.) with client specific reports to identify the gapsMust have a prior experience in implementing/maintenance of commercial payer claims solution and/or Medicare/Medicaid systemMust have good experience with claims processing concepts, along with the provider, member enrolment and care management conceptsMust have good experience in Reference code/data sets required in Claims adjudication including not limited to CPT, CDT, HCPCS, ICDsMust have prior experience or understanding in configuring benefits or programs in claims system across various sub-systemsMust be able to work with the clients to create/gather requirements and document them according to standardsMust adhere to (or if needed, define) the processes for requirement solicitation, documentation and hand offShould work closely with the IT development team to elucidate the requirements, enable constructive discussions / brainstorming sessions to implement the best in class solutionShould have basic understanding concepts like web services, relational databases etcShould be able to run queries and perform basic system analysis, RCA etcShould be able to create mapping documents for the various interfaces and include business rules, transformation and DB mappingShould work closely with the client and development team during the stages of development, and conduct demos at completion of milestone, track and close feedback from such demosMust have excellent written and spoken communication skills. Should be able to multitask between internal team and clients based on priority tasksWork Closely with Dev, architecture and Design teams to define the GUI view and platform requirements, which is the foundation of the productSkillsMust have a prior experience in implementing/maintenance of commercial payer claims solution and/or Medicare/Medicaid systemMust have good experience with claims processing concepts, along with the provider, member enrolment and care management conceptsMust have good experience in Reference code/data sets required in Claims adjudication including not limited to CPT, CDT, HCPCS, ICDsMust have prior experience or understanding in configuring benefits or programs in claims system across various sub-systemsMust be able to work with the clients to create/gather requirements and document them according to standardsMust adhere to (or if needed, define) the processes for requirement solicitation, documentation and hand offShould work closely with the IT development team to elucidate the requirements, enable constructive discussions / brainstorming sessions to implement the best in class solutionShould have basic understanding concepts like web services, relational databases etcShould be able to run queries and perform basic system analysis, RCA etcShould be able to create mapping documents for the various interfaces and include business rules, transformation and DB mappingShould work closely with the client and development team during the stages of development, and conduct demos at completion of milestone, track and close feedback from such demosMust have excellent written and spoken communication skills. Should be able to multitask between internal team and clients based on priority tasksWork Closely with Dev, architecture and Design teams to define the GUI view and platform requirements, which is the foundation of the productCapability to think out-of-the-box to create new solutions as neededPrior experience as a IT QA or Developer in a healthcare system would be helpful though not mandatoryAbility to validate Test scenarios and test plans, test dataShould be able to Review requirements, documentation and create Requirements Traceability matrix (RTM)Should have excellent communication (written and spoken) skills to engage with different stakeholders like QA/dev team, clients, end users of Clients and Business UnitsAbility to assess current functionality available in a product vis a vis market trends, regulatory requirements to be implemented in future version of the productAbility to drive and share the requirements with Technical and Architects regarding product features to be implementedMS Visio to define the different views like System, technical, functional and role based viewAwareness defect tracking and version control tools like Jira, TFM, DevOps AzureDB client to write data queries to validate data updated in the database tableCompany OverviewGroup Nine LLC provides staffing solutions for companies seeking top talent. It was founded in 2010, and is headquartered in Farmington Hills, Michigan, US, with a workforce of 51-200 employees. Its website is http://groupninellc.com/.