Job Information
Deloitte PEMS/Claims Business Analyst in Austin, Texas
PEMS Team Operations/Portals Business Analyst
The team
Deloitte's Government and Public Services (GPS) practice - our people, ideas, technology and outcomes-is designed for impact. Serving federal, state, & local government clients as well as public higher education institutions, our team of over 15,000+ professionals brings fresh perspective to help clients anticipate disruption, reimagine the possible, and fulfill their mission promise.
Deloitte's Health Technology offering transforms the way the Healthcare IT market embraces modernization and modularization. Using our deep health, government, and technology consulting experience, our team strategically advises on design as well as implements and deploys solutions. In order to help clients reduce costs, improve health outcomes, and respond to public health crises, our Health Technology practice addresses critical health agency issues including: claims management, electronic health records, health information exchanges, health analytics, and health case management.
How you'll growAt Deloitte, our professional development plan focuses on helping people at every level of their career to identify and use their strengths to do their best work every day. From entry-level employees to senior leaders, we believe there's always room to learn. We offer opportunities to help sharpen skills in addition to hands-on experience in the global, fast-changing business world. From on-the-job learning experiences to formal development programs, our professionals have a variety of opportunities to continue to grow throughout their career.
Work you'll doRole Summary:
Works with application development and/or application maintenance in the application domain in a Medicaid, MMIS setting or in a health insurance Managed Care Organization setting.
Claims and encounters:
EDI X12 837 claims management for FFS claims
EDI Clearinghouse
Encounter data processing from a Medicaid perspective
Medicaid and CHIP data warehouse and operational data store for claims and encounter sub systems
Eligibility:
Medicaid eligibility determination
Pricing, rate setting, contracts
Pricing and rate setting application development
Fee for service price schedule management
MCO FFS request management
Long term care and behavioral health
Long term care (LTC) portal including clinical assessment submission, online authorization
Behavioral health- contract and payment management, enrollee management, KPI and metrics management
Portals and outreach
Member and provider portals including enrollment and eligibility inquiries, requesting ID cards, provider search, FFS pricing requests made by providers
Authorization submission and data management
Electronic visit verification management
EDI X12 270/271 eligibility benefit enquiry
Reporting and analytics for Medicaid and CHIP claims, enrollment, rates, providers
Batch and interface operations including FTP, scheduling and error handling within specified SLAs
Required Qualifications:
15+ years of Health Claims experience
State Medicaid system experience
PEMS and C21 experience
Experience with UAT and file mapping
Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future
Desired Qualifications:
Understanding of functional design process
SQL experience
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or protected veteran status, or any other legally protected basis, in accordance with applicable law.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or protected veteran status, or any other legally protected basis, in accordance with applicable law.