Business Analytics Advisor
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The job profile for this position is Business Analytics Advisor, which is a Band 4 Senior Contributor Career Track Role.
Excited to grow your career?
We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply!
Our people make all the difference in our success.
As an enabler of Enterprise Strategic Priority for Medicare Advantage Growth, the DMOM program will drive a competitive administrative cost structure while delivering consistent, compliant operational performance. This will be accomplished through the implementation of a new operating model - transformation across people, process, and technology.
The Business Acceptance Testing (BAT and UAT) tester is responsible for developing and executing testing to ensure results align to expectations.
This individual will report to the BAT Lead. This individual will collaborate and communicate frequently with other BAT Testers or members of the technical and solution teams. This individual must possess an understanding of business processes and capabilities.
This position supports the Provider Reimbursement/Claims Pricing, Capitation and Claims Intake team
Primary Responsibilities
Prepare and create test scenarios that match real life claims processing.
Participate in analysis of business processes to drive test workflows.
Create and execute the testing of business process scenarios for all aspects of Medicare business including provider matching, provider fallout, member validation, enrollment, disenrollment, MOOP/OOP, benefit terms, Rules and Rates, procedure codes, appeals.
Assist in preparation of compliance testcases reviewing compliance controls using samples from previous audit findings, CMS program audit, HIPPA guidelines, CMS reports etc. Ensure the business scenarios are executed on the system to support high quality and compliant solution.
Create configuration testcases for product and benefit setup, COB, CMS mandates, EGWP, Service and procedure codes, Accumulators etc.
Coordinate with Business SME and Business process optimization to understand various aspects of business needs
Work with Test data and Test environment teams on deployment schedule for BAT environment readiness for testing
Coordinate necessary access on tools/platforms to enable BAT testing
Gain a deep working knowledge of Medicare business, IT landscape, and coordinate collaboration across BAT team
Drive automation where possible for all BAT testing in collaboration with BAT Automation Engineers
Identify and document defects, issues, risks and dependencies
Develop and execute test scripts, test conditions, input test data, and expected results for Business Acceptance Testing/ User Acceptance Testing
Prepare Production checkout plan, data and scenarios working with business SME and end users
Coordinate with Product Owner, Technical Leads, Product Managers and QA on readiness for release and timeline
Measure and report test coverage across all applicable coverage dimensions
Ensure appropriate testing tasks are scheduled during release, iteration planning
Participate proactively in daily standup meetings, story grooming sessions, team retrospectives and suggest improvements
Establish standard processes for managing end user feedback, triaging issues and routing to and from product and engineering.
Provide recommendations for Go/ No Go release decisions
Minimum Qualifications
Bachelor's degree or equivalent experience required
Two or more years of related business or healthcare experience.
Candidate should have strong claim processing understanding, and advanced knowledge of health care coding, fee schedules and reimbursement methodologies
Knowledgeable with high complexity, high volume transaction healthcare claim environment
Experience in Quality Assurance and/or Business Acceptance Testing
Knowledge of data model/database design concepts and working knowledge of SQL
Experience in FACETS is preferred
Ability to work with shifting priorities to meet project requirements; self-motivated
Attention to detail, with strong analytical and problem-solving skills
Excellent written and oral communication skills
Experience working with multiple groups, both internally and externally - clients, engineering and product management teams
Ideal candidate will be resilient
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this .
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
Excited to grow your career?
We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply!
Our people make all the difference in our success.
As an enabler of Enterprise Strategic Priority for Medicare Advantage Growth, the DMOM program will drive a competitive administrative cost structure while delivering consistent, compliant operational performance. This will be accomplished through the implementation of a new operating model - transformation across people, process, and technology.
The Business Acceptance Testing (BAT and UAT) tester is responsible for developing and executing testing to ensure results align to expectations.
This individual will report to the BAT Lead. This individual will collaborate and communicate frequently with other BAT Testers or members of the technical and solution teams. This individual must possess an understanding of business processes and capabilities.
This position supports the Provider Reimbursement/Claims Pricing, Capitation and Claims Intake team
Primary Responsibilities
Prepare and create test scenarios that match real life claims processing.
Participate in analysis of business processes to drive test workflows.
Create and execute the testing of business process scenarios for all aspects of Medicare business including provider matching, provider fallout, member validation, enrollment, disenrollment, MOOP/OOP, benefit terms, Rules and Rates, procedure codes, appeals.
Assist in preparation of compliance testcases reviewing compliance controls using samples from previous audit findings, CMS program audit, HIPPA guidelines, CMS reports etc. Ensure the business scenarios are executed on the system to support high quality and compliant solution.
Create configuration testcases for product and benefit setup, COB, CMS mandates, EGWP, Service and procedure codes, Accumulators etc.
Coordinate with Business SME and Business process optimization to understand various aspects of business needs
Work with Test data and Test environment teams on deployment schedule for BAT environment readiness for testing
Coordinate necessary access on tools/platforms to enable BAT testing
Gain a deep working knowledge of Medicare business, IT landscape, and coordinate collaboration across BAT team
Drive automation where possible for all BAT testing in collaboration with BAT Automation Engineers
Identify and document defects, issues, risks and dependencies
Develop and execute test scripts, test conditions, input test data, and expected results for Business Acceptance Testing/ User Acceptance Testing
Prepare Production checkout plan, data and scenarios working with business SME and end users
Coordinate with Product Owner, Technical Leads, Product Managers and QA on readiness for release and timeline
Measure and report test coverage across all applicable coverage dimensions
Ensure appropriate testing tasks are scheduled during release, iteration planning
Participate proactively in daily standup meetings, story grooming sessions, team retrospectives and suggest improvements
Establish standard processes for managing end user feedback, triaging issues and routing to and from product and engineering.
Provide recommendations for Go/ No Go release decisions
Minimum Qualifications
Bachelor's degree or equivalent experience required
Two or more years of related business or healthcare experience.
Candidate should have strong claim processing understanding, and advanced knowledge of health care coding, fee schedules and reimbursement methodologies
Knowledgeable with high complexity, high volume transaction healthcare claim environment
Experience in Quality Assurance and/or Business Acceptance Testing
Knowledge of data model/database design concepts and working knowledge of SQL
Experience in FACETS is preferred
Ability to work with shifting priorities to meet project requirements; self-motivated
Attention to detail, with strong analytical and problem-solving skills
Excellent written and oral communication skills
Experience working with multiple groups, both internally and externally - clients, engineering and product management teams
Ideal candidate will be resilient
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this .
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.
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