*Hi,*
*Please reply to ,*
* vin...@1pointsys.com <vin...@1pointsys.com>*
*Position: **Lead Systems Analyst *
*Location: Santa Ana, CA or Eden Prairie, MN*
*Duration: 6 Months+ *
*Need USC/GC/GC EAD and Local Candidate for This Position.*
*Project: *
Our client is making a major capital investment to build a new product
solution for the Medicaid fee for service claims market. The industry
traditionally refers to these as Medicaid Management Information Systems
(MMIS).
*Primary Responsibilities: *
• Contribute to the product development efforts for one or more of the
functional domains outlined below to meet the Medicaid Management
Information System (MMIS) market and operational needs:
o Member Management
o Claims Processing
o Constituent Services (Portals, CRM, Contact management, etc.)
o Financial Management
• Evaluate business requirements and prepare the detailed functional and
technical specifications that follow project guidelines and Optum standards
• Communicate design to all stakeholders and varying levels of the
organization
• Work closely with the Engineering team in delivering a solution that
meets the defined requirements
• Collaborate with QA team to ensure testing efforts align with
functionality
• Maintains up-to-date knowledge of current trends in Government
Information Technology solutions, issues in healthcare, national and
statewide standards and legislation's, and changing policies and procedures
Required Qualifications:
• 5+ years of experience in playing a business/functional/systems analyst
in defining system functionality and delivering system capabilities to meet
market / business needs
• 3+ years In-depth knowledge of one or more of the functional domains
specified above
• Proficiency with Requirements Management, Agile Development and other
SDLC related tools
• Willingness and ability to travel up 25% to in the US
• Bachelor's Degree or equivalent work experience
Preferred Qualifications:
• Specific MMIS experience in one or more of these functional domains
specified above
• Hands on experience with structured SDLC methodologies preferably Agile
• Ability to work independently with limited general supervision.
• Strong technical and non-technical communication skills
*Required:*
· Provider: Health Plan or MMIS experience with Provider management,
provider enrollment
· Member: Health Plan or MMIS experience with Member management, member
health plan enrollment. Integrated eligibility / insurance experience is
somewhat relevant but does not fully meet the need.
· Claims: Resource must have either MMIS Claims or Facets Claims
experience. Depending on the need, there may be more granular requirements
for Claims Entry, Claims Pricing, Claims Adjudication/Editing
· Financial: Health Plan or MMIS experience with Financial Management
and/or Claims Payment
· TPL: MMIS Third Party Liability (TPL) experience. Due to the nuances of
Medicaid TPL, non-MMIS TPL experience likely will not suffice
· Service Auth / Clinical / Utilization Management Health Plan / MMIS /
QIO experience in one / all of these areas. Experience with the Aerial
platform is a bonus
· Constituent Health Plan or MMIS experience with constituent services –
Portals, IVR, Call center, CRM packages. When the CRM solution is
determined for OMMS, specific experience with that CRM may be required).
· ODS/Reporting Health Plan or MMIS experience collaborating with data
architects to design/build operational data stores (ODS) for the purpose of
developing/configuring operational reports.
· Configuration Facets configuration experience
· Technical Technically oriented AWOs/BSAs for areas such as EDI, Document
Management, etc.
*Other Must Haves: *In this industry, methods (Agile) can be taught much
more quickly than the functional domain complexities. Functional domain
experience is paramount.
*Vineet Mishra*
*Technical Recruiter*
1 Point System LLC
Unit 103, 206 N College St, Pineville, North Carolina, 28134
*P*: *803-317-2541* *E* : vin...@1pointsys.com
*Yahoo:* vineet1point...@yahoo.com *Hangout: *vineet1po...@gmail.com
*W:* www.1pointsys.com
For Job Updates please add: *1 Point System-Jobs/Hotlist*
*[image: cid:image001.jpg@01D1C23B.DB35CC10]*
*An E-Verified company | An Equal Opportunity Employer*
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