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We are seeking a Senior Business Analyst with deep expertise in Medicaid Third Party Liability (TPL), claims processing, and recovery operations. The ideal candidate will have hands-on and in-depth experience and knowledge with Medicaid Management Information System (MMIS), Coordination of Benefits (COB), Crossovers – (Medicare A & B), Medicare Advantage C plans (MCA), and post-payment recovery workflows. The TPL SR BA will support Business Operations Support (BOS) for a state Medicaid Program. Working under the direction of the Operations Manager, the analyst will collaborate with state business staff, system and service vendors, and NTT DATA project managers and consultants to support planning, design, User Acceptance Testing (UAT), implementation, and evaluation of key system and processes changes.
Job Responsibility
Analyze Medicaid claims, TPL workflows, Medicare Crossovers (Pt A&B), Medicare Advantage (Pt C), and recovery data to identify trends, root causes, and opportunities for cost avoidance and recovery optimization
Translate federal/state TPL policies into system requirements
Support MMIS enhancements, including adjudication rules and edits, reporting, letters, etc.
Work with vendors and state stakeholders to improve all faucets of insurance discovery and recovery processes
Lead requirements gathering, documentation, create and conduct UAT testing
Identify and report issues, risks, and dependencies
Support issue triage, backlog management, and operational reporting for day-to-day TPL activities
Requirements
Minimum 10 years of experience supporting large, complex Medicaid system implementation projects and/or Medicaid business operations
Minimum 8 years of experience with TPL to include a combination of the following: Coordination of Benefits, Medicare Crossover Part (A&B) Claims processing, Medicare Advantage (Part C), claims workflows, including complex claim scenarios and regulatory compliance
Minimum 6 years of experience with elicitation and verification of business and technical requirements
Minimum 3 years of experience with system development methodology and project management principles
Minimum 3 years of experience conducting reviews of system development life cycle documentation, project and technical architecture and design deliverables/artifacts
Undergraduate degree or 4 years relevant experience
Nice to have
Candidate must be local to the client in Little Rock, Arkansas
Experience translating Federal and State regulations into working requirements that are actionable by technical teams
Experience working with Medicaid Enterprise Systems (MES) vendors
Ability to translate between non-technical business users and technical IT resources
Strong SQL and data analysis skills
Strong understanding of HIPAA and X12 EDI standards
What we offer
medical insurance
dental insurance
vision insurance with an employer contribution
flexible spending or health savings account
life and AD&D insurance
short and long term disability coverage
paid time off
employee assistance
participation in a 401k program with company match