Easter Seals Jobs

Business Analysis Advisor -Medicare- DMOM

Location: Remote-Work at Home

Primary Responsibilities

• Prepare and create test scenarios that match real life claims processing.

• Participate in analysis of business processes to drive test workflows.

• Create and execute the testing of business process scenarios for all aspects of Medicare business including provider matching, provider fallout, member validation, MOOP/OOP, benefit terms, Rules and Rates, procedure codes, appeals.

• Prepare compliance testcases reviewing compliance controls using samples from previous audit findings, CMS program audit, HIPPA guidelines, CMS reports etc. Ensure the business scenarios are executed on the system to support high quality and compliant solution.

• Create configuration testcases for product and benefit setup, COB, CMS mandates, EGWP, Service and procedure codes, Accumulators etc.

• Coordinate with Business SME and Business process optimization to understand various aspects of business needs

•Work with Test data and Test environment teams on deployment schedule for BAT environment readiness for testing

• Coordinate necessary access on tools/platforms to enable BAT testing

•Gain a deep working knowledge of Medicare business, IT landscape, and coordinate collaboration across BAT team

•Drive automation where possible for all BAT testing in collaboration with BAT Automation Engineers

•Identify and document defects, issues, risks and dependencies

•Develop and execute test scripts, test conditions, input test data, and expected results for Business Acceptance Testing/ User Acceptance Testing

•Prepare Production checkout plan, data and scenarios working with business SME and end users

•Coordinate with Product Owner, Technical Leads, Product Managers and QA on readiness for release and timeline

•Measure and report test coverage across all applicable coverage dimensions

•Ensure appropriate testing tasks are scheduled during release, iteration planning

•Participate proactively in daily standup meetings, story grooming sessions, team retrospectives and suggest improvements

•Establish standard processes for managing end user feedback, triaging issues and routing to and from product and engineering.

•Provide recommendations for Go/ No Go release decisions

Minimum Qualifications

• Bachelor’s degree or equivalent experience required; HS Diploma required

• Five or more years of experience in Testing and Quality Engineering

• Two or more years of related business or healthcare experience.

• Candidate should have strong claim processing understanding, and advanced knowledge of health care coding, fee schedules and reimbursement methodologies

• Knowledgeable with high complexity, high volume transaction healthcare claim environment

• Experience in Quality Engineering and/or Business Acceptance Testing

• Knowledge of data model/database design concepts and working knowledge of SQL

• Experience in QNXT is preferred

• Ability to work with shifting priorities to meet project requirements; self-motivated

• Attention to detail, with strong analytical and problem-solving skills

• Excellent written and oral communication skills

• Experience working with multiple groups, both internally and externally – clients, engineering and product management teams

This role is Work at Home which allows most work to be performed at home. Employees must be fully vaccinated if they choose to come onsite.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

About The Cigna Group

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.