Associate Business Analyst - Chennai - Wipro Ltd
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Mandatory Skills:Business Analysis Job Description:
Key skills required for the job are:
Business Analysis (Mandatory)
Minimum work experience: 5- 6 YRSYears
Specific working experience in endto end policy administration & processing platforms likeFacets, Proclaim, etc , and should have experience with some of thefollowing functional areas based on their core experience. Skillsets are commonfor onshore and offshore from a domain perspective.
1.Membership and Eligibility: Eligibility and Member Enrollment, Premium Billing Transactions, AccountReceivable, Letter and ID Validations, Client and Customer setup?conceptsand as established in practicum and as configured in processingplatforms?and Maintenance.
2.Enterprise Service Business: Strong understanding of the work flow and data flow of major healthcare insurerprocesses: especially claims and eligibility
3.EDI and Gateway Testing: Strong Businessknowledge on HIPAA 5010 EDI Transactions including Claims 835,837, Eligibility inquiry (270/271), Certification request (278), etc.
4. Benefits: Knowledge of Benefits Configuration and Validations, benefits setup, Accumulators function,logic, and Validation? in concept and as enabled within the platforms
5. Capitation: Knowledge ofcapitation and other value-based reimbursement incentive payments
6. Providers: Knowledge ofprovider network maintenance; contracting (pricing / Value Based Reimbursement)
7. Banking: Knowledge of EFTtransactions.
8 Knowledge of healthcare payerdata, especially as conceptualized in logical data models?hierarchical,relational, or dimensional
9. Knowledge of ETL processsteps Roles & Responsibilities:
Minimum Experience Required: 1-3 YEARS
Mandatory Skills: Business Analysis
Language Skills: English Language