TPL Senior Business Analyst at Sierra Systems, An Ntt Data Company

TPL Senior Business Analyst

NTT DATA Services is seeking a TPL Senior Business Analyst to join our team in Little Rock, Arkansas (US-AR), United States (US). We are looking for a Senior Business Analyst with deep expertise in Medicaid Third Party Liability (TPL), claims processing, and recovery operations. The ideal candidate will have hands-on and in-depth experience and knowledge with Medicaid Management Information System (MMIS), Coordination of Benefits (COB), Crossovers (Medicare A & B), Medicare Advantage C plans (MCA), and post-payment recovery workflows. The TPL SR BA will support Business Operations Support (BOS) for a state Medicaid Program. Working under the direction of the Operations Manager, the analyst will collaborate with state business staff, system and service vendors, and NTT DATA project managers and consultants to support planning, design, User Acceptance Testing (UAT), implementation, and evaluation of key system and processes changes.

Key Responsibilities:

• Analyze Medicaid claims, TPL workflows, Medicare Crossovers (Pt A&B), Medicare Advantage (Pt C), and recovery data to identify trends, root causes, and opportunities for cost avoidance and recovery optimization
• Translate federal/state TPL policies into system requirements
• Support MMIS enhancements, including adjudication rules and edits, reporting, letters, etc.
• Work with vendors and state stakeholders to improve all faucets of insurance discovery and recovery processes
• Lead requirements gathering, documentation, create and conduct UAT testing
• Identify and report issues, risks, and dependencies
• Support issue triage, backlog management, and operational reporting for day-to-day TPL activities

Required Qualifications:

• Minimum 10 years of experience supporting large, complex Medicaid system implementation projects and/or Medicaid business operations
• Minimum 8 years of experience with TPL to include a combination of the following: Coordination of Benefits, Medicare Crossover Part (A&B) Claims processing, Medicare Advantage (Part C), claims workflows, including complex claim scenarios and regulatory compliance.
• Minimum 6 years of experience with elicitation and verification of business and technical requirements
• Minimum 3 years of experience with system development methodology and project management principles
• Minimum 3 years of experience conducting reviews of system development life cycle documentation, project and technical architecture and design deliverables/artifacts
• Undergraduate degree or 4 years relevant experience

Preferred Skills:

• Candidate must be local to the client in Little Rock, Arkansas
• Experience translating Federal and State regulations into working requirements that are actionable by technical teams
• Experience working with Medicaid Enterprise Systems (MES) vendors
• Ability to translate between non-technical business users and technical IT resources
• Strong SQL and data analysis skills
• Strong understanding of HIPAA and X12 EDI standards

Where required by law, NTT DATA provides a reasonable range of compensation for specific roles. The starting pay range for this remote role is $91,260 - $152,100. This range reflects the minimum and maximum target compensation for the position across all US locations. Actual compensation will depend on a number of factors, including the candidate's actual work location, relevant experience, technical skills, and other qualifications. This position may also be eligible for incentive compensation based on individual and/or company performance. This position is eligible for company benefits including medical, dental, and vision insurance with an employer contribution, flexible spending or health savings account, life and AD&D insurance, short and long term disability coverage, paid time off, employee assistance, participation in a 401k program with company match, and additional voluntary or legally-required benefits.