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