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Business Systems Consultant
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- Performs configuration change management activities related to benefits, business rules, screen design and functionality, templates, workflows, provider contracts, user task analysis, personalization to different plans, and user interface design and design requirements for systems setup, configurations and onboarding of new plans/providers.
- Translates configuration rules, fee schedules, contract terms, provider data code sets, and benefits into systems parameters to ensure accurate managed care operations (i.e. enrollment & billing, claims processing, etc
- This job supports one or more analytical aspects of the application product life cycle, including capability enablement with cross-team dependencies within a product scope.
- Remains informed of all health plan contracts and amendments as well as code sets, fee schedule and pricing changes made by health plans, CMS and/or the states’ Medicaid programs.
- Create and maintain deliverables such as business vision, requirements, testing plan, testing schedule, testing scenarios, testing outcomes, user task analysis, wire framing, usability testing, personalization to different clients, and user interface design.
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