*Business Analyst w/ICD10 - 12+ months - Direct Client *
*Immediate Interview and Start ASAP!!!*



*Please send resume to s...@cncconsulting.com *


Job Title: Business Analyst w/ICD10
Location: Columbia, SC
Duration: 12 Months
Direct Client Position

DAILY DUTIES / RESPONSIBILITIES:
A Replacement MMIS Subject Matter Expert (SME) is responsible for
evaluating agency needs, as-is and to-be business processes, and solution
designs to provide analysis and advice on strategies for information
technology solutions and non-technical solutions. The majority of the
system development work will be outsourced to vendors and other State
organizations.
Duties include:
• Requirements development execution, including the elicitation, analysis,
specification and validation.
• Documenting and analyzing agency business processes and recommending
improvements.
• Documenting and analyzing data requirements and relationships.
• Participate in the requirements management processes, including change
control; version control; tracking and status reporting; and traceability.
• Providing requirement interpretation and guidance to technical and test
teams.
• Proactively identifying risks, issues, and action items leading to
possible solutions.
• Interacting with internal and external organizations (i.e. vendors, State
and Federal government agencies, State providers and beneficiaries, and
other stakeholders).
• Planning for, conducting, and reporting on testing and other quality
assurance activities.
• Other related activities.
Subject matter areas include: provider management, member (beneficiary)
management/eligibility, claims (professional, institutional, pharmacy,
dental, durable medical equipment, transportation, etc.), third party
liability, financial management, reimbursement methodology, drug rebate,
prior authorization, managed care, behavioral health, long-term care,
program integrity, electronic health records, benefit plan administration,
etc.
Familiarity with ICD-9/ICD-10 coding standards, X12 EDI transactions, and
the Affordable Care Act and it impacts on Medicaid eligibility and health
insurance exchanges is also beneficial.

REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE):
• General Medicaid or Medicare Experience Required.
• Strong background and proven experience in healthcare insurance business
operations (payer or provider side; government or commercial side).
Experience in multiple business areas is a plus. Note: IT operations are
not the same as business operations.
• At least one year experience in healthcare insurance IT software/systems
implementations performing duties described in the “Daily
Duties/Responsibilities” section above.
• Ability to properly document business requirements.
• Ability to interpret business process and business data models.
• Superb written and oral communications skills, including the ability to
give presentations to executive management. Strong proficiency in English
is required.
• Impeccable integrity. This project will have very high visibility and
will impact significant expenditures of public funds. Candidates must be
confident with their abilities to make correct decisions and the courage to
speak out when necessary.
• Willingness and ability to effectively engage with people and
organizations on a continuous basis.

PREFERRED SKILLS (RANK IN ORDER OF IMPORTANCE):
• Understanding of the Medicaid Information Technology Architecture (MITA).
• Understanding of the Medicaid Enterprise Certification Toolkit (MECT).
• Vendor management experience.
• Experience in an outsourced healthcare insurance operations environment.
• Experience on an outsourced IT development project.
• Experience in creating business process and business data models.
• Public sector procurement experience is a plus.


*Please send resume to s...@cncconsulting.com *

Thanks,
Sam
CNC Consulting, Inc.
201-546-3096
s...@cncconsulting.com

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