Remote opportunity at
OmegaHiresSenior Business Analyst
OmegaHires is seeking a Senior Business Analyst to act as the Claims Domain lead for healthcare projects in a remote role. This full-time position suits an…
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About This Role
OmegaHires is seeking a Senior Business Analyst to act as the Claims Domain lead for healthcare projects in a remote role. This full-time position suits an experienced professional who can guide the claims module, coordinate with clients, and ensure high quality standards throughout the project life cycle. The analyst will analyze business needs, prepare documentation, troubleshoot application issues, and assist clients with implementation choices. Additionally, the role involves conducting milestone…
Job Description
OmegaHires is seeking a Senior Business Analyst to act as the Claims Domain lead for healthcare projects in a remote role. This full-time position suits an experienced professional who can guide the claims module, coordinate with clients, and ensure high quality standards throughout the project life cycle. The analyst will analyze business needs, prepare documentation, troubleshoot application issues, and assist clients with implementation choices. Additionally, the role involves conducting milestone demonstrations, gathering feedback, and partnering with architecture, development, and design teams to shape platform and GUI specifications. Candidates must possess a strong background in the healthcare sector, particularly with Medicaid, Medicare, and claims processing. OmegaHires offers a collaborative team environment where professionals can leverage their expertise in claims lifecycles, EDI formats, and database querying.
Responsibilities
- Serve as the Claims Domain lead for healthcare projects
- Manage the claims module and process to guarantee quality and client coordination
- Analyze business needs and create design and development documentation
- Help customers with implementation decisions and troubleshoot application errors
- Provide guidance across the entire project life cycle within a team environment
- Lead milestone demonstrations and monitor feedback gathered from them
- Partner with architecture, development, and design teams to establish platform and GUI view needs
- Communicate across internal teams and clients based on task priorities
Requirements
- Extensive healthcare domain background with solid understanding of Medicare and Medicaid
- Practical background in claims processing and adjudication
- Familiarity with sets utilized in claims adjudication
- Understanding or prior background in configuring benefits or programs within claims systems across sub-systems
- Capability to execute queries and carry out basic system and root cause analysis
- Strong written and verbal communication skills
- Comprehensive knowledge of the claims lifecycle encompassing member, provider, claim submission, adjudication, payment cycle, and reporting
- Knowledge of claim types such as professional, dental, institutional, and pharmacy
- Familiarity with EDI X12 formats including 837P/I/D, 835, 834, 270/271, and 276/277
- Familiarity with claims systems like CMdS, GHS, and Facets
- SQL proficiency for backend table data validation
- Experience using EDI tools to validate X12 files
- Comprehension of interface testing and data flows via tools like Postman
Qualifications
- Minimum of eight or more years of experience in healthcare, specifically within the MMIS domain
- Ability to devise creative solutions as needed
- Capacity to validate test data, test plans, and test scenarios
- Background in reviewing requirements and documentation to build a Requirements Traceability Matrix
- Skill in assessing current product features against market trends and regulatory rules for future updates
- Ability to drive and communicate product feature requirements to technical teams
Core Skills
Frequently Asked Questions
Answers are based only on the employer’s listing; where it doesn’t say, neither do we.
Is this position remote?
Yes, the posting specifies that the role is remote.
What is the employment type?
The role is full-time.
What is the salary for this role?
The job posting does not specify the salary.
What core technical skills are required?
Candidates must be proficient in SQL for validating backend data, experienced with EDI tools for X12 file validation, and familiar with interface testing and data flow tools like Postman.
Sample Interview Questions
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