Healthcare Business Analyst

Responsibilities

Create/maintain Business Requirements Document (BRD)

Create/Maintain Requirements Traceability Matrix (RTM)

Develop supporting diagrams (process flows, context diagram)

Develop business, functional \& non-functional requirements

Facilitate Business Owner review

Build UAT scenarios

Provide input on client University project training plan

Provide input on project status report

Provide input on project change control

Assist Project Manager w/transition plan activities

Escalate issues/risks to Lead BA (if applicable) \& Project Manager

Assist Business Owner with documenting current or future state process flows

Assist Project Manager to create operations \& support plan

Obtain approvals on deliverables

Assist the project team in estimating the impact of change requests on timelines, budgets, resources and project scope

Develop requirements management plan (RMP)

Create/maintain Business Requirements Document (BRD) as necessary

experience in using Azure Devops for product management lifecycle

Collaborate w/Integration Test Lead to create UAT scenarios

Assist Program Manager to create operations \& support plan

Provide input on program status report

Provide input on program change control

Assist Program Manager w/transition plan activities

Escalate issues/risks to Program Manager

Mentor other BA’s in proper processes and standards

Requirements

Expertise in Health Plan's Provider space -specifically Provider Information and Provider Data

Provider Demographics, Credentialing, Contracting, Fee schedule, and Hierarchy (provider, group, systems, etc), Provider Networking

Provider vendor onboarding processes

Strong E2E background in Health Plan in Clinical space

Knowledge of Clinical Policy

Knowledge of HealthEdge's Guiding Care system

Working with Electronic Health Records (EHRs)

Care Management Experience (Assessments, Statisfication, Letters)

Utilization Management (Channels, Codes, Turn Around Times, Policies), Prior auth

Process assessment for Clinical Vendor onboarding/extensions

Healthcare plan enrollments and EDI files

Pharmacy healthcare processes, Pharmacy operations and Data

Understanding of how Pharmacy claims are paid. Knowledge of Formularies, files exchange process with PBM's

Claims adjudication process. Understanding of claims data and systems (FACETS)

Understanding of claims billing practices.

Understanding of compliance and regulatory reporting and CMS guidelines

Research reporting related requirements in state and federal contracts and regulations

Understanding of Program Integrity function and Reporting

Define processes for documentation of reporting requirements, sharing of reporting requirements with the larger team.

Understanding of reporting databases

Understanding of Healthcare equity.

Social Determinants of Health and processes with Community Based Org.

Vendor discontinuation processes.

Understanding of Health Information Exchange function

Knowledge of Call Center Operations

Understanding of HEDIS, Quality Management

Knowledge of Value Based Reimbursement and trends

Understanding of Electronic Visit Verification process

Facilitate requirements elicitation sessions

Capgemini is an Equal Opportunity Employer encouraging diversity in the workplace. All qualified applicants will receive consideration for employment without regard to race, national origin, gender identity/expression, age, religion, disability, sexual orientation, genetics, veteran status, marital status or any other characteristic protected by law.

This is a general description of the Duties, Responsibilities and Qualifications required for this position. Physical, mental, sensory or environmental demands may be referenced in an attempt to communicate the manner in which this position traditionally is performed. Whenever necessary to provide individuals with disabilities an equal employment opportunity, Capgemini will consider reasonable accommodations that might involve varying job requirements and/or changing the way this job is performed, provided that such accommodations do not pose an undue hardship.

Capgemini is committed to providing reasonable accommodation during our recruitment process. If you need assistance or accommodation, please reach out to your recruiting contact.

Please be aware that Capgemini may capture your image (video or screenshot) during the interview process and that image may be used for verification, including during the hiring and onboarding process.

Click the following link for more information on your rights as an Applicant http://www.capgemini.com/resources/equal-employment-opportunity-is-the-law

Applicants for employment in the US must have valid work authorization that does not now and/or will not in the future require sponsorship of a visa for employment authorization in the US by Capgemini.

Capgemini discloses salary range information in compliance with state and local pay transparency obligations. The disclosed range represents the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting, although we may ultimately pay more or less than the disclosed range, and the range may be modified in the future. The disclosed range takes into account the wide range of factors that are considered in making compensation decisions including, but not limited to, geographic location, relevant education, qualifications, certifications, experience, skills, seniority, performance, sales or revenue-based metrics, and business or organizational needs. At Capgemini, it is not typical for an individual to be hired at or near the top of the range for their role. The base salary range for the tagged location is [$75,000 - $85,000)

This role may be eligible for other compensation including variable compensation, bonus, or commission. Full time regular employees are eligible for paid time off, medical/dental/vision insurance, 401(k), and any other benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.