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

This is a fully remote position, open to applicants in India.

📋 Description

• Examine the requirements of Federal and State Medicaid policies.

• Convert policy requirements into BPA rule specifications.

• Develop decision tables, rule mapping documents, and business rule specifications.

• Analyze and provide support for Benefit Plans, Assignment Plans, Provider Contracts, Reimbursement Rules, Copay Rules, Audit Rules, and Form Edit Rules.

• Comprehend how BPA affects claim adjudication.

• Assess coverage decisions, validate provider eligibility, check provider contracts, and oversee reimbursement processing.

• Review and confirm BPA Rule Sheets.

• Assist in managing the BPA Rule Sheet release process.

• Evaluate approvals and manage configuration promotions.

• Conduct rule impact analyses.

• Validate scenarios with overlapping rules.

• Support the governance of BPA Rule Sheets.

• Establish acceptance criteria.

• Create BPA test scenarios.

• Carry out policy compliance verifications.

• Collaborate with Business Analysts, DOM Subject Matter Experts, Operations, Reference teams, Developers, and Testing teams to design, configure, validate, and sustain BPA rule solutions.

⛳️ Requirements

• Proven BPA Subject Matter Expert with expertise in the Medicaid domain.

• In-depth knowledge of MS MES Business Policy Administration.

• Experience in Medicaid Claims Processing.

• Background in Medicaid Policy Interpretation.

• Proficiency in Benefit Plan Analysis.

• Experience in Assignment Plan Analysis.

• Expertise in Provider Contract Analysis.

• Skilled in BPA Rule Analysis.

• Ability in Requirements Gathering.

• Competence in Impact Analysis.

• Adept at Business Rule Documentation.

• Proficient in SQL.

• Knowledgeable in Oracle.

• Familiarity with C Programming.

• Experienced in Pro*C.

• Competent in Unix/Linux.

• Skilled in Data Mapping.

• Proficient in Query Analysis.

• Experienced in using Business Rules Editor (BRE).

• Knowledgeable about Rule Sheets.

• Familiar with Benefit Classifications.

• Experienced in Rule Metadata.

• Knowledgeable about Rule Variables.

• Familiar with Benefit Plan Hierarchies.

• Experienced in Provider Contracts.

• Knowledgeable in Rule Configuration Lifecycle.

• MES/MESA experience is preferred.

• Experience with Medicaid Enterprise Systems is preferred.

• Knowledge of Claims Adjudication is preferred.

• Familiarity with Provider Enrollment & Maintenance is preferred.

• Knowledge of Reference Data is preferred.

• Experience with Rule Engines is preferred.

🏝️ Benefits

• Comprehensive health insurance plans.

• Competitive salary with performance bonuses.

• Opportunities for professional development and career advancement.

• Flexible work schedule with remote work options.

• Generous paid time off and holiday leave.