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Business Analyst, Reimbursement

Business Analyst, Reimbursement
Company:

(Confidential)


Place:

Assam


Job Function:

Other

Details of the offer

Evolent Health is looking for a Business Analyst, Implementation to be a key team player within the Business Analyst team and be responsible for requirements management of the implementation work across our client and Evolent organizations. As a Reimbursement Business Analyst, you will play an integral role in provider contract pricing implementation with our partner, business operations teams and our provider contract intelligence platform vendor. What Youll Be Doing Define business requirements and acceptance criteria/test cases that support provider contract pricing implementation for new clients by working as a critical bridge between the partner, internal business operations teams and the provider contract intelligence platform vendor Work closely with the partner and business operations team to develop and evaluate business requirements to determine the most efficient implementation of clinical editing and provider pricing reimbursement methodologies Build and manage the provider contract inventory for new client implementations Build and manage contract interpretations worksheet with any updates to contracts and fee schedules Manage workflow and communication with the provider contract intelligence platform vendor to ensure timely and accurate implementation of provider contracts Build and maintain any business and workflow documentation needed to support provider contract implementation process Provider executive reporting on status of contract completion and maintain upward communication on any roadblocks Perform requirements review with external and internal stakeholders and obtain sign off from all required individuals Create and standardize business requirements documentation processes and workflows Manage BRD deadlines with necessary tools for completion tracking and clearly identifying open items that need inputs from stakeholders Identify issues upfront and communicate clearly to the management Participates in the management of the sequencing of releases to meet business needs for enhancements, automations, and implementations Ensures continuing operational support by documenting changes and enhancements Provide training to staff on need basis and act as a mentor for new team members The Experience Youll Need (Required) Extensive knowledge in health insurance third party administrator concepts for provider functions in one or more of these programs Medicaid, Medicare Advantage, Exchange and Commercial 2 years of experience in claim adjudication platforms with an understanding of provider reimbursement methodology In-depth knowledge of medical, dental billing and coding Knowledge of health insurance, HMO and managed care principles including Medicaid and Medicare regulations Advanced understanding of the connection of a provider to a contract or fee schedule for reimbursement calculations Advanced understanding of Clinical Editing (for example, NCCI, CCI) Advanced understanding of reimbursement methodologies (for example, Medicare reimbursements (PPS), DRG, APDRG, ASC, fee schedules, RVUetc.) Strong communication and facilitation skills Strong time management and organizational skills Excellent interpersonal, oral, and written communication skills Strong attention to detail and organization Able to work independently and within a collaborative team environment with little guidance/supervision 2 years of computer skills, especially Word, Excel, Visio, Power Point, and SharePoint 3 years of experience leading projects and cross functional teams Ability to successfully balance deadlines, projects, and day to day responsibilities Finishing Touches (Preferred) BS/BA Degree Reimbursement or Coding Certification 6 years of experience in Systems Analysis, Configuration Analysis, Design, Documentation, and / or Development & testing 5 years of experience translating business requirements into detailed system specification Experience working with CA Exchange market including delegation arrangements Comprehensive knowledge of the Healthcare markets and products


Source: Bebee

Job Function:

Requirements


Knowledges:
Business Analyst, Reimbursement
Company:

(Confidential)


Place:

Assam


Job Function:

Other

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