*PM/BA need *
*Bellingham, WA*
*Duration 5 months*
*Rate: $40-43hr*
*Must have 8+ years as a Business Analyst with a strong background in
healthcare payer environments. Must have 2+ years as a PM and excellent
comm skills.*
*Client is seeking a Project Manager / Business Analyst with strong
healthcare payer EDI background with a focus on the 835/837 transaction
sets. Prospective candidates should have the following experience:*
*Required:*
The PM / Business Analyst’s role is to collaborate with project
stakeholders in the business community and IT. He/She will document and
communicate requirements, including communication of the requirements to
the development and test teams throughout this engagement.
The candidate will apply proven communication, analytical, and
problem-solving skills to help support the solution design and development
process, and to ensure that project deliverables are met according to
specifications. He/she will play a pivotal role in ensuring IT
understanding of requirements and serve as liaison between business and
technology staff, identifying and resolving any gaps in understanding.
*Job Description*:
- Elicit business and user requirements via interviews, workshops,
questionnaires
- Develop and utilize standard templates to accurately and concisely
write requirements specifications
- Translate conceptual business and user requirements into functional
requirements in a clear manner that is comprehensible to testers and
developers and/or the project team
- Manage and track the status of project through the engagement
- Communicate changes, enhancements, and modifications of requirements
according to the established process
- Validate that test cases provide full coverage of requirements and
participate in defect triage
- Support requirements throughout all phases
*Skills:*
- Excellent communications skills, both written and verbal
- Demonstrated Business Analyst experience with a specific focus on
Requirements, Test Plan and execution support
- Demonstrated Project Management skills and experience with a specific
focus on task management, project status reporting, and timely deliverables
- Experience working with BRD’s, TRD’s and FRD’s
- Direct experience with the 835/837 EDI transaction sets
- Familiarity / experience with the following EDI standards and formats:
- X12N/005010X221, Version 5, Release 1
- CAQH CORE Phase III rules
- 5010 format
- Prior experience with Medicare Supplemental (Med-Supp) plans and
processing is highly desireable
- EDI X.12 experience
- HIPAA EDI X12 experience is preferred
- 837 Claims processing
- 835 Claim payment advice – content and operating rules
- HIPAA 4010 & 5010 experience
- CORE Phase III Rules experience
- Must have working familiarity with CORE Phase III rule sets
including:
- #350: Healthcare Claim Payment advice (835)
- #360: Uniform use of CARC / RARC (835)
- #370: EFT & ERA Re-association (CCD+835)
- #380: EFT Enrollment Data Rule
- #382: ERA Enrollment Data Rule
- Candidates should have working knowledge of the following concepts
as they relate to 835/837/acknowledgment transactions:
- CARC – Claim Adjustment Reason Code
- CCD+ - Cash Concentration or Disbursement Plus Addendum
- RARC – Remittance Advice Remark Codes
- EFT – Electronic Funds Transfer
- ERA – Electronic Remittance Advice
- EFT – Electronic Funds Transfer
*Thanks and Regards*
*Shweta Ojha*
Technical Recruiter | Sage Group Consulting
3400 Highway 35 S,Suite# 9,Hazlet, NJ,USA 07730
*Direct*: 732-784-6492 | *Email*: [email protected]
*Gtalk*: sojha1290|*Yim*: ojha1290
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