Healthcare BA/Claims Processor

Job ID: NC-652457 (93690603)Healthcare BA/Claims Processor with MMIS, NCTracks/payment system, rules, claims, regulatory and MS Office experienceLocation: Raleigh, NC (NCDHHS)Duration: 12monthsInterview: Either Webcam Interview or In PersonPositions:1(1/1)Skills :’Experience working with NC Medicaid RequiredExperience with NCTracks RequiredExperience working with claims adjudication/reprocessing RequiredExperience with gathering requirements RequiredAn understanding of claim edits and audits RequiredStrong organizational, time management, communication, and detail-oriented skills RequiredExcellent communication, negotiation, conflict resolution and persuasion abilities RequiredStrong understanding of health care strategy, operations, technology, and regulatory requirements RequiredPosition Overview:This position will serve as a member of the Business Technology Relationship Management team. The unit is responsible for managing relationship between the DHB program/functional areas and the Technology that supports the business and supports all of the division.Job Specific ResponsibilitiesReview of various claims reports to perform in-depth claim analysis, validation of system changes, and review of edits/audits in order to make recommendations to maintain the integrity of the reprocessing.Provide incident monitoring, problem ticket, incident creation and troubleshooting.Defect ResolutionRequesting System EnhancementsPreferred Knowledge, Skills, and Abilities:Experience working with NC MedicaidExperience with NCTracksExperience with gathering requirementsExperience working with claims adjudication/reprocessingAn understanding of claim edits and auditsStrong understanding of health care strategy, operations, technology, and regulatory requirementsDemonstrated ability to work independently in a fast-paced environment with concurrent deadlinesExcellent communication, negotiation, conflict resolution and persuasion abilitiesStrong organizational, time management, communication, and detail-oriented skillsHighly proficient with Microsoft Outlook, Word and ExcelNW-652457.docx