Experienced Business Analyst - Claims Configuration - QNXT

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.

Summary

As a Experienced Business Analyst - Claims Configuration - QNXT at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges.

Your primary responsibility is to analyze and document business processes, gather and define requirements, and collaborate with stakeholders to ensure the successful implementation of solutions that meet the unique challenges and requirements of the healthcare industry. The successful candidate will be an intellectually curious, self-directed individual with excellent organizational skills and attention to detail. This role is highly collaborative in nature providing support for IT and business teams. Performs complex analyses of State Medicaid Policies, and Legacy System business rules from data extracts.

Here are the details on this position.

Your role in our mission

Play a critical part in ensuring Gainwell is meeting our clients’ objectives in important areas

.Analyzes client requests and applies advanced subject matter knowledge to solve complex business issues and is regarded as a subject matter expert

• Adheres to and supports Configuration team approach and other configuration principles, methodologies, and practices
• Ensures communication among all key stakeholders
• Exercises significant independent judgment within broadly defined policies and practices to determine best method for accomplishing work and achieving objectives
• May provide mentoring and guidance to lower-level employees
• Works closely with the Configuration team to analyze and determine if business rules cannot be configured within the system.  If cannot be configured, communicates the rules via a Stored Procedure Specification Document so a Custom Stored Procedure can be developed.
• Creates test cases from functional requirements, executing test cases, and documenting results
  Participates in technical reviews and inspections to verify 'intent of change' is carried out through the entire project
• Provide accurate status and time reporting for project related tasks

....your role continued

• Ability to read Custom Stored procedures
• Medicaid Systems work experience
• Ability to exercise discretion and independent judgment
• Analyzes configuration data and structure to isolate defects
• Research and define solutions for new configuration, legislation, or client rules
• Creates proof of concept testing for new business processes or outcome requests
• Creates and presents solution, proof of concept, or testing results to customer 
• Completes configuration within schedule timelines and configuration best practices

What we're looking for

• Six or more years of business analysis experience
• Ability to create and maintain highest levels of confidentiality when dealing with proprietary or private information
• Four or more years’ experience configuring in QNXT:
  • Contracts/benefits
  • Claims Pricing methodologies
  • System data points needed for successful X12 transactions, Claim Adjustment Reason Codes and Remittance Advice Code
  • Contracts for provider services, benefits for member coverage, fee schedules, capitation, and claim editing enforcement.
• Experience working with Medicaid/MMIS systems. 
• Experience processing Medicaid claims and ability to troubleshoot adjudication results
• Understands Medicaid Program structure in carriers, programs, benefit plans, policy, policy plans, sponsor, and orgpolicies.
• Understands Provider (Contract and Pricing) data including but not limited to provider type, specialty, taxonomy, enrollment impacts, service locations, certifications and licensing, affiliations, and reimbursement impacts.
• 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

Technical skills

• Bachelor's degree or equivalent combination of education and experience.  Bachelor's degree in business administration, information systems, or related field preferred
• Highly proficient in the use of Microsoft Office Products (PowerPoint, Excel, Word. Visio, Outlook)
• Preferred experience working with HP Application Lifecycle Management (ALM)
• Experience writing SQL queries for data analysis
• Preferred experience includes DDI (Design, Development, and Implementation) and operations phases
• Experience working with complex systems at a detailed level  
• Understands relational database concepts and schemas
• Demonstrated aptitude for learning new technologies and keeping current with industry best practices

Soft skills

Communication:

• Openly and actively communicates information and takes initiative to communicate extensively.
• Strong written and verbal communication skills to ensure clarity
• Presentation skills to present to management and customers

Team and Goal oriented:

• Experience working in a virtual team environment performing self-directed tasks.
• Ability to work in a collaborative team environment to achieve a common goal
• Interpersonal skills to interact with customers and team members

Analytical and problem-solving:

• Ability to exercise sound judgment and make decisions in a manner consistent with the essential job functions.
• Adaptable to changing priorities
• Handles difficult situations diplomatically

Multitasking and reliability:

• Regular and reliable attendance is an essential function of this position
• Ability to manage multiple priorities ensuring deadlines are achieved
• Ability to work in a remote environment, self-directed with minimal supervision
• Ability to multi-task and maintain organization in a fast-paced environment

What you should expect in this role

• Fully remote options from most US locations and territories
• Video cameras must be used during all interviews, as well as during the initial week of orientation
• The deadline to submit applications for this posting is October 22, 2024

#LI-HC1

#LI-Medicaid Claims Configuration

#LI-QNXT

The pay range for this position is $69,400.00 - $99,200.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.