Description
Job Description: Client is seeking a Senior Pharmacy BA Lead to perform Business Analysis work related to support the Managed Care Transition Project.
This position is responsible for the following activities : Demonstrated knowledge in creating test scenarios/cases in consultation with the business owners, hands-on testing, test results review, and proactively identifying issues and providing resolutions/recommendations
Proven knowledge in Medicaid or similar claims ( pharmacy) processing systems
Extensive knowledge of pharmacy claims and business policies
Thorough knowledge of system functional areas such as recipient, provider, prior authorization, reference, program integrity, financial and claims
Thorough knowledge of Federal and State regulations, statutes, and rules
Knowledge base/experience with encounter claims and be ready to lead any work effort pertaining to encounter claims
Expert knowledge on SQL, EDI, X12, NCPDP, HL7, HIPAA PHI, ICD-10
Clear understanding of the deliverables process, e.g. System Documentation release,
Working knowledge of defect process
Proven experience with the system development life cycle (SDLC)
Experience working on large Federal/State contracts
Proficient with Microsoft Word, Excel, Visio, Project, OneNote, Outlook, and PowerPoint
