PACE1129 Business Analyst

Columbia, SC

Company Description

Headquartered in Columbia, MD, PACE Computer Solutions is a leading provider of end-to-end technology consulting service for initiatives ranging from Emerging Technologies (Cloud/Open Source) and Application Management Services (full life cycle) to Systems/Enterprise Applications Integration and Business Intelligence.  We support the Federal, DoD and Commercial sectors providing resources for various client initiatives. PACE Computer Solutions again was named, for the third consecutive year, to INC. 500/5000 magazine's "Fastest Growing Private Companies" list in our industry.


For additional information on how PACE Computer Solutions can support your job search call 877.225.PACE or visit us at www.pace-solutionsinc.com.

Job Description

DAILY DUTIES / RESPONSIBILITIES: A Replacement MMIS Subject Matter Expert (SME) is responsible for evaluating agency needs, as-is and to-be business processes, and technical designs to provide analysis and advice on strategies for information technology solutions and non-technical solutions. The majority of the system development work will be outsourced to vendors and other State organizations.
Duties include:

• Requirements development execution, including the elicitation, analysis, specification and validation.

• Documenting and analyzing agency business processes and recommending improvements.

• Documenting and analyzing data requirements and relationships.

• Participate in the requirements management processes, including change control; version control; tracking and status reporting; and traceability.

• Providing requirement interpretation and guidance to technical and test teams.

• Proactively identifying risks, issues, and action items leading to possible solutions.

• Interacting with internal and external organizations (i.e. vendors, State and Federal government agencies, State providers and beneficiaries, and other stakeholders).

• Planning for, conducting, and reporting on testing and other quality assurance activities.

• Other related activities.
Subject matter areas include: provider management, member (beneficiary) management/eligibility, claims (professional, institutional, pharmacy, dental, durable medical equipment, transportation, etc.), third party liability, financial management, reimbursement methodology, drug rebate, prior authorization, managed care, behavioral health, long-term care, program integrity, electronic health records, benefit plan administration, etc.
Familiarity with ICD-9/ICD-10 coding standards, X12 EDI transactions, and the Affordable Care Act and it impacts on Medicaid eligibility and health insurance



• Finance experience required on Project planning and financial budgeting • Training and experience in financial analysis and assessment;

• Experience in the financial analysis of large health data systems;

• Experience in government Medicaid financial reporting;

• Experience in state Medicaid MARS/SURS financial analysis and reporting;

• Strong background and at least six years experience in healthcare insurance business operations (payer or provider side; government or commercial side). Note: IT operations are not the same as business operations.

• At least four years experience in healthcare insurance IT software/systems implementations performing duties described in the “Daily Duties/Responsibilities” section above.

• Ability to properly document business requirements.

• Ability to create/interpret business process and business data models.

• Vendor management experience – • Superb written and oral communications skills, including the ability to give presentations to executive management. Strong proficiency in English is required.

• Impeccable integrity. This project will have very high visibility and will impact significant expenditures of public funds. Candidates must be confident with their abilities to make correct decisions and the courage to speak out when necessary.

• Willingness and ability to effectively engage with people and organizations on a continuous basis.

• Agile, waterfall, SDLC, PLC • Requirements gathering experience

• Understanding of the Medicaid Information Technology Architecture (MITA).

• Understanding of the Medicaid Enterprise Certification Toolkit (MECT).

• Experience in an outsourced healthcare insurance operations environment.

• Experience on an outsourced IT development project.

• Experience in creating business process and business data models.

• Public sector procurement experience is a plus

REQUIRED EDUCATION: Bachelor’s degree.