Summary
The position supports required data integration and transformation processes crucial to the implementation and function of the Gainwell Medicaid Fiscal Agent services product.
Serves as a data analyst performing research and requirement analysis, creation and design of data specifications and mapping documents, and presents findings to appropriate
team members, clients and vendors. Determines best practices and provides suggestions on how to improve current practices.
Job Description
o Facilitates and/or participates in JAD (Joint Application Design), RAD (Rapid Application Development) and DSD (Design Specifications Document) sessions to define and understand
the business requirements and present detailed systems design documentation for data interface files, data conversion and any other method of data exchange.
o Works aggressively to define project scope. Ties data interface roster elements back to a valid requirement.
Works with the customer and account management to control the scope of the project.
o Responds to action items by assigned due dates.
o Escalates concerns to project management, such as delays or risks of delays as early as possible.
o Creates accurate data mapping documents according to the mapping process.
o Works toward delivering a first draft solution to ETL developers for coding, by rapidly understanding which details about the mapping can be deferred.
o Supports DSD creation and response.
o Works closely with configuration team to ensure synchronicity of configuration to interfaces and mappings.
o Refines mapping documents, adding more detail and filling out deferred material as questions are resolved.
o Uses SQL, data models, data element dictionary and schema to perform data and business analysis.
o Creates unit test cases for area of responsibility.
o Supports Unit Testing, System Integration Testing, System Testing, and User Acceptance Testing.
Previous Work with analyzing, monitoring healthcare plan data focusing on medical claim and financial processing member eligibility processing, provider networks and MCO contract details, auditing and reporting in compliance with Federal and State requirements
Knowledge of Payment Reform methodologies under the Affordable Care Act and related initiatives in the Medicaid space
Analytical and data analysis skills using Microsoft SQL (required)
Healthcare knowledge within a claims processing environment preferably in Medicaid
What we're looking for
4 years data analysis and business knowledge within a healthcare environment and testing arena
3-5 years of Microsoft SQL experience specifically using SQL to analyze healthcare data.
3+ years experience with QNXT or FACETS
5-10 years in Medicaid IT, including experience with HIPAA code sets and business rules
2+ years experience with state Medicaid agencies and/or vendors focusing on analysis or provider, member and claims data.