Assists in analysing and documenting client's business requirements and processes; Communicates these requirements to technical personnel by constructing configuration deliverables
- Adheres to and supports Configuration team approach and other configuration principles, methodologies, and practices
- Analyses configuration data and structure to isolate defects
- Experience with Configuration Implementation Build & Maintenance
- Research and define solutions for new configuration, legislation, or client rules.
- Experience configuring in QNXT or FACETS
- Understands Medicaid Program structure in carriers, programs, benefit plans, policy, policy plans, sponsor, and or policies.
- Understands Provider (Contract and Pricing) data
- 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
- Understands relational database concepts and schemas
- Experience writing SQL queries for data analysis
- Experience processing Medicaid claims and ability to troubleshoot adjudication results
- Assists in creating basic test scenarios to verify that client requirements are incorporated into the system design.
- Assists in developing and modifying systems requirements documentation to meet client needs.
- Participates in meetings with clients to gather and document requirements and explore potential solutions.
- Business analysis experience in U.S. Medicaid management preferred
