Sr. Healthcare Business Analyst
Current• Designing and developing Kansas Medicaid Account for ICD 10 (International classification of disease) changes for Benefit Plan Administration (BPA) Sub-system, Financials, Claims, Managed Care, Recipient, Prior Authorizations, EDI (Electronic Data Interchange), Reference, EDMS (Electronic Data Management System), and EPSDT (Early Periodic Screening Diagnosis and Treatment) system.• Involved in gathering business requirements, design and development for the BPA, EPSDT, EDMS, EDI, Claims, Financials, Recipient, Prior Authorization and Managed Care modules.• Ensured all artifacts compiled with HIPAA 5010 policies and guidelines.• Worked on EDI transactions like 270,271,834,837 and 835.• Gathering requirements and preparing functional documents for Facets 4.71.• Worked with the business/functional unit to assist in the development, documentation, and analysis• of functional and technical requirements within FACETS.• Did gap analysis for HIPAA4010 837P and 835 transactions and HIPAA 5010 837P and 835 transactions.• Responsible for gap analysis in changing old MMIS and Involved in testing new MMIS. Also, accountable for Medicaid Claims Resolution/Reimbursement for peach state health plan using MMIS.
