Business Analyst - Consultant

Location: Columbia, South Carolina
Date Posted: 08-27-2018
Location: Columbia, SC
Duration: 12 months

**US Citizens or Green Card Holders Only**


The Replacement MMIS project is among the most complex IT projects taken on by the State’s Department of Health and Human Services. This project is a multi-year effort to replace many of the State’s aging Medicaid systems with modern technologies and supporting business operations. 

This position requires an individual with strong analytical skills and experience in: 
  •  Claims Processing in a large health care payer environment
  •  Provider Enrollment and Management
  •  Member Eligibility and related functions

The principal duties of this position are to develop and maintain business requirements with associated artifacts such as requirements plans, process flows, and other models as needed.

Daily work will concentrate on these work streams:
• Member
• Provider
• Claims
• Prior Authorization
• Finance
These work streams will support the following modules for RMMIS:
• Business Intelligence System
• Administrative Services Organization (ASO) for Fee for Service (FFS) claims
• Pharmacy Benefits Administrator (PBA)
• Dental Administrative Services Organization (DASO)
• Accounting and Finance
• Third Party Liability (TPL)
• System Integration and Operations (SIOPS)
• Technology Framework (Integration Hub, Portal and Enterprise Data Services)
• RMMIS Program Management
Specific duties include, but are not limited to:
• Plan, elicit, capture, analyze and validate business, functional and technical requirements.
• Facilitate requirements elicitation sessions and walkthroughs with business and IT resources.
• Collaborate with departments to identify, document and communicate business needs and provide solutions.
• Develop business rules via interviews, translation of governing documents and other means.
• Conduct JAD Sessions with Product Owners
• Partner with business owners on requirements development and project collaboration
• Assist other team members in performing business rules, requirements, and modeling duties.
• Research business rules, requirements, and models.
• Use case development
• Requirements traceability


• 8+ years’ experience in government IT projects as a business analyst or related duties
• 6+ years’ experience eliciting, mining, and documenting business rules
• General Subject Matter Expertise as it relates to Medicaid or other healthcare insurance experience (project or operations)
• Firm understanding of health care payer business process
• Strong understanding of business modeling techniques
• Integrated healthcare delivery from member enrollment though to claims payment
• Business operations experience in member enrollment though to claims payment
• Ability to effectively communicate to executive management, line management, project management, and team members. 
• Experience and ability to obtain business rules and requirements information by interviewing business personnel and by mining laws, regulations, and policy documents.
• Superb written and oral communications skills, including the ability to write requirements and Use Cases. Very Strong proficiency in English is required

Bachelor’s degree in a technical, business, or healthcare field.
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