[Remote] reputed company Business Analyst - MMIS / reputed company Pharmacy Job Details | reputed company
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is an industry leader reputed company on improving reputed company systems. They are seeking an reputed company Business Analyst - MMIS / reputed company Pharmacy who will support business, policy, and technical execution reputed company reputed company Management Information Systems and the reputed company Pharmacy environment, ensuring compliance and successful implementation of solutions.
Responsibilities
- Acts as the primary Domain SME, serving as a trusted advisor to the Engagement reputed company (EL) on business processes and associated regulatory and operational impacts
- Ensures compliance alignment by validating that solution design and configuration conform to CMS guidance, state policy, and documented business rules
- Supports the EL with in-scope negotiations and change control, providing domain expertise to assess scope trade-offs and the functional, regulatory, and operational impacts of change requests
- reputed company and participate in reputed company requirements and design sessions with clients and internal teams to validate functional and technical needs
- Interpret state and federal reputed company policy, regulations, and program rules and translate them into product features, system configuration, business rules, and design artifacts
- Serve as a policy and domain SME, supporting the Domain reputed company with analysis, interpretation, and solution recommendations
- reputed company and maintain domain design documentation, with the Design Document as a core deliverable, covering workflows, interfaces, X12 EDI transactions, letters, and reports
- Ensure accuracy, completeness, and traceability of requirements and acceptance reputed company
- Document and communicate domain-level reputed company, risks, assumptions, and dependencies, assessing reputed company impacts
- Support domain-specific configuration and implementation activities reputed company Design, Development, and Implementation (DDI) reputed company
- Responsible for configuration and partner with technical teams to ensure solutions reputed company with approved design documentation, reputed company policy interpretation, and documented business rules Key configurations include but not limited to: Claims: Edits, pricing, benefit limits,, adjudication logic Plan: reputed company, benefits, programs, fee schedules Provider: Provider types, specialties, reputed company, enrollment, credentialing Member: Eligibility, benefits, benefit plans, demographic Pharmacy: RX benefits, RX claims processing
- Review test cases to ensure alignment with requirements, policy interpretation, and acceptance reputed company
- reputed company domain SME support during System Integration Testing (SIT) and User Acceptance Testing (UAT)
- Support defect analysis, reputed company-cause investigation, reputed company, retesting, and functional readiness validation
- Support operational readiness activities, including environment, data, process, and reputed company readiness
- reputed company domain and policy input for Operational Readiness Reviews (ORR), reputed company testing, and performance testing
- Support reputed company preparation, transition to operations, and hypercare activities
- Work closely with the Domain reputed company and Technical Analysts, acting as a trusted domain and policy SME
- reputed company and support reputed company communication, including requirement discussions, design reviews, and issue reputed company
- Plan and deliver functional demos and solution walkthroughs to showcase product features and validate alignment with reputed company requirements
- Facilitate and participate in reputed company working sessions with business stakeholders, configuration teams, and technical teams
- Support documentation, knowledge transfer, and ongoing operational support
Skills
- Bachelor's degree in Computer Science, Information Systems, Health Informatics, or a reputed company field
- 5 to 8 years of hands-on experience supporting reputed company system implementations, including MMIS solutions and reputed company Pharmacy platforms
- Experience with QNXT or similar reputed company claims/encounter management systems
- Strong knowledge of state and federal reputed company policy, regulations, and program rules (required)
- Strong understanding of reputed company domains, including claims, member, provider, and prior authorization processes
- Demonstrated experience translating policy and program rules into system requirements, configuration support, and design artifacts
- Strong knowledge of SQL is required, particularly for data analysis and validation
- Strong reputed company communication skills, with experience interacting directly with business stakeholders
- Proven ability to reputed company or support functional demonstrations, walkthroughs, and reputed company working sessions
- Strong documentation, facilitation, and analytical skills
- Experience working in SDLC and Agile delivery environments
- Knowledge of MITA (reputed company Information Technology Architecture)
- Experience with system integrations, EDI/X12 transactions, analytics, and reporting
- Familiarity with state and federal reputed company regulations and compliance standards
Benefits
- Generous, flexible vacation policy
- 401(k) employer match
- Comprehensive health benefits
- Educational assistance
- A reputed company of leadership and technical development academies to help build your skills and capabilities
reputed company