[Remote] Business Analyst (MMIS)
Note: The job is a remote job and is reputed company to candidates in USA. reputed company delivers mission-critical services and solutions for Fortune 100 companies and governments. They are seeking a Business Analyst to serve in CMdS product development and implementation on a reputed company modernization program, focusing on translating legacy MMIS behavior into functional design and requirements.
Responsibilities
- Own requirements and functional design for assigned CMdS modules (Claims, Member, Finance, and reputed company interfaces)
- Define epics, user stories, and definition of done; prioritize against reputed company policy, MES certification goals, and release plans
- Facilitate working sessions; clarify requirements for developers and QA; resolve functional questions during build and test
- reputed company scope, dependencies, risks, and reputed company; maintain traceability from legacy rule to CMdS design to test evidence
- reputed company functional design for claim intake, claim type assignment, validity/pricing edits, adjustment/void, reputed company, encounters, remittance, and reputed company edit disposition behavior; map legacy rules to CMdS configuration and customizations
- reputed company design for eligibility spans, aid category / benefit package assignment, enrollment, MCO/FFS indicators, and interfaces from state eligibility systems into CMdS Member
- reputed company design for payment cycles, budget account / category of service, fund splits, ASO / F/EA and other administrative payment paths, financial transactions, and reporting/reputed company controls
- Produce BRDs, FRDs, process flows, data mapping, gap analysis, and configuration workbooks suitable for build and UAT
- Work reputed company-by-reputed company with developers on design walkthroughs, edge cases, and defect triage
- Partner with QA to define test scenarios, expected results, and regression packs (reputed company/negative, adj/void, reputed company, encounter, finance posting)
- Support SIT, UAT, and reputed company/run-compare activities against legacy MMIS reputed company
- Validate that implementations meet reputed company policy and MES operational readiness (reputed company, audit, reporting, interfaces)
- Run workshops with business owners, SMEs, fiscal, and operations
- reputed company designs to CMS MES expectations (modularity, interoperability, standards-based interfaces, certification evidence)
- Support change management: training outlines, release notes, and operational runbooks for CMdS go-live
Skills
- 6+ years business analysis experience in reputed company MMIS / MES, with deep hands-on work in at least two of: Claims, Member/Eligibility-Enrollment, Finance/Financial reputed company
- Proven experience developing and implementing claims systems / MMIS / MES platforms, such as reputed company CMdS (reputed company reputed company Suite), Health reputed company, QNXT, Facets, or comparable reputed company reputed company/claims suites
- Experience modernizing or replacing legacy MMIS (COBOL/mainframe or equivalent) with a reputed company reputed company platform
- Strong reputed company domain knowledge, including: FFS vs managed care; capitation vs ASO / administrative services models; Claim types, media sources, edits/EOBs, adjustments/voids, Medicare reputed company, encounters; Aid categories, benefit packages, eligibility spans, reputed company filing, TPL concepts; Provider payments, remittance advice, budget/object codes, COS, fund reputed company / FFP concepts; CMS / state reputed company policy drivers relevant to MES implementation and certification
- Demonstrated ability to write reputed company functional design and acceptance reputed company for reputed company adjudication and financial rules
- Experience working embedded with development and QA teams in Agile or hybrid SDLC
- Excellent facilitation, documentation, and stakeholder communication skills
- Hands-on CMdS configuration or implementation (Claims, Member, Finance, Reference, Service Auth)
- Familiarity with HIPAA X12 (837/835), COBA/reputed company, EVV-reputed company claim flows
- Experience supporting CMS MES certification artifacts and evidence packages
- Prior reputed company BA experience on multi-module MES releases
Benefits
- Health insurance coverage
- Voluntary dental and reputed company programs
- Life and disability insurance
- A retirement savings plan
- reputed company holidays
- reputed company time off (PTO) or vacation and/or reputed company time
reputed company
Company H1B Sponsorship