Role OverviewWe are seeking a Senior Business Analyst with deep expertise in Medicaid Third Party Liability (TPL), claims processing, and recovery operations. The ideal candidate will have hands-on and in-depth experience and knowledge with Medicaid Management Information System (MMIS), Coordination of Benefits (COB), Crossovers – (Medicare A & B), Medicare Advantage C plans (MCA), and post-payment recovery workflows.
What You Will Do
The TPL SR BA will support Business Operations Support (BOS) for a state Medicaid Program. Working under the direction of the Operations Manager, the analyst will collaborate with state business staff, system and service vendors, and NTT DATA project managers and consultants to support planning, design, User Acceptance Testing (UAT), implementation, and evaluation of key system and processes changes.
Why It Might Be a Fit
The ideal candidate will have hands-on and in-depth experience and knowledge with Medicaid Management Information System (MMIS), Coordination of Benefits (COB), Crossovers – (Medicare A & B), Medicare Advantage C plans (MCA), and post-payment recovery workflows.
Requirements
- Minimum 6 years of experience supporting large, complex Medicaid system implementation projects and/or Medicaid business operations
- Minimum 6 years of experience with TPL, Coordination of Benefits, Medicare Crossover Part (A&B) Claims processing, Medicare Advantage (Part C), claims workflows, including complex claim scenarios and regulatory compliance.
- Minimum 6 years of experience with elicitation and verification of business and technical requirements
- Minimum 3 years of experience with system development methodology and project management principles
- Minimum 3 years of experience conducting reviews of system development life cycle documentation, project and technical architecture and design deliverables/artifacts
Benefits
- Medical insurance
- Dental insurance
- Vision insurance
- Flexible spending or health savings account
- Life and AD&D insurance
- Short and long term disability coverage
- Paid time off
- Employee assistance
- Participation in a 401k program with company match
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