Business Analyst Cmds Claims, Member & Finance Implementation (Mes)
The Dignify Solutions, LLCEdison, NJ
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Overview
Remote
On-site
Job Description
Delivery & analysis
- Own requirements and functional design for assigned CMdS modules (Claims, Member, Finance, and related interfaces).
- Define epics, user stories, and definition of done; prioritize against Medicaid policy, MES certification goals, and release plans.
- Facilitate working sessions; clarify requirements for developers and QA; resolve functional questions during build and test.
- Track scope, dependencies, risks, and decisions; maintain traceability from legacy rule to CMdS design to test evidence.
Functional design (Claims, Member, Finance)
- Claims: Lead functional design for claim intake, claim type assignment, validity/pricing edits, adjustment/void, crossover, encounters, remittance, and related edit disposition behavior; map legacy rules to CMdS configuration and customizations.
- Member: Lead design for eligibility spans, aid category / benefit package assignment, enrollment, MCO/FFS indicators, and interfaces from state eligibility systems into CMdS Member.
- Finance: Lead design for payment cycles, budget account / category of service, fund splits, ASO / F/EA and other administrative payment paths, financial transactions, and reporting/accounting controls.
- Produce BRDs, FRDs, process flows, data mapping, gap analysis, and configuration workbooks suitable for build and UAT.
Collaboration with Development & QA
- Work side-by-side with developers on design walkthroughs, edge cases, and defect triage.
- Partner with QA to define test scenarios, expected results, and regression packs (positive/negative, adj/void, crossover, encounter, finance posting).
- Support SIT, UAT, and parallel/run-compare activities against legacy MMIS outcomes.
- Validate that implementations meet Medicaid policy and MES operational readiness (security, audit, reporting, interfaces).
- Stakeholder & MES engagement
- Run workshops with business owners, SMEs, fiscal, and operations.
- Align designs to CMS MES expectations (modularity, interoperability, standards-based interfaces, certification evidence).
- Support change management: training outlines, release notes, and operational runbooks for CMdS go-live.
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FAQs About Business Analyst Cmds Claims, Member & Finance Implementation (Mes) Jobs at The Dignify Solutions, LLC
What is the work location for this position at The Dignify Solutions, LLC?
This job at The Dignify Solutions, LLC is located in Edison, NJ, according to the details provided by the employer. Some roles may also include multiple work locations depending on the requirement.
What pay range can candidates expect for this role at The Dignify Solutions, LLC?
Employer has not shared pay details for this role.
What employment applies to this position at The Dignify Solutions, LLC?
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