Business Process Analysis SME, Medicaid Domain, C/Pro*C Programming

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🔥 0 minutes ago

🇮🇳 India – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Business Operations

👻 Ghost score 10%

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Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

📦 Logistics

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Consulting • Logistics • Healthcare Insurance

Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.

📋 Description

• Analyze Federal and State Medicaid policy requirements • Translate policy requirements into BPA rule specifications • Create decision tables, rule mapping documents, and business rule specifications • Analyze and support Benefit Plans, Assignment Plans, Provider Contracts, Reimbursement Rules, Copay Rules, Audit Rules, and Form Edit Rules • Understand how BPA impacts claim adjudication • Analyze coverage determination, provider eligibility validations, provider contract validations, and reimbursement processing • Review and validate BPA Rule Sheets • Support the BPA Rule Sheet release management process • Review approvals and configuration promotions • Perform rule impact analysis • Validate overlapping rule scenarios • Support BPA Rule Sheet governance • Create acceptance criteria • Develop BPA test scenarios • Perform policy compliance verification • Collaborate with Business Analysts, DOM SMEs, Operations, Reference teams, Developers, and Testing teams to design, configure, validate, and maintain BPA rule solutions

🎯 Requirements

• Experienced BPA SME with Medicaid domain expertise • Strong understanding of MS MES Business Policy Administration • Experience with Medicaid Claims Processing • Experience with Medicaid Policy Interpretation • Benefit Plan Analysis • Assignment Plan Analysis • Provider Contract Analysis • BPA Rule Analysis • Requirements Gathering • Impact Analysis • Business Rule Documentation • SQL • Oracle • Working knowledge of C Programming • Working knowledge of Pro*C • Unix/Linux • Data Mapping • Query Analysis • Business Rules Editor (BRE) • Rule Sheets • Benefit Classifications • Rule Metadata • Rule Variables • Benefit Plan Hierarchies • Provider Contracts • Rule Configuration Lifecycle • MES/MESA Experience preferred • Medicaid Enterprise Systems preferred • Claims Adjudication Knowledge preferred • Provider Enrollment & Maintenance preferred • Reference Data Knowledge preferred • Rule Engine Experience preferred