Previous Job
Business Analyst - Healthcare
Ref No.: 16-00043
Location: columbia, South Carolina
Position Type:Contract
Start Date / End Date: 11/01/2016 to 11/01/2017
Project Description:
The Replacement MMIS project is among the most complex IT projects taken on by the State's Department of Health and Human Services. This project is a multi-year effort to replace many of the State's aging Medicaid systems with modern technologies and supporting business operations.

This role:
Serves as a liaison between the business community and the IT organization in order to provide technical solutions to meet user needs. Possesses expertise in the business unit(s) they support, as well as, an understanding of the IT organization's systems and capabilities. Analyzes business partner's operations to understand their strengths and weaknesses to determine opportunities to automate processes and functions. Assists in the business process redesign and documentation as needed for new technology. Translates high level business requirements into functional specifications for the IT organization and manages changes to such specifications. Educates the IT organization on the direction of the business. Negotiates agreements and commitments by facilitating communication between business unit(s) and IT from initial requirements to final implementation. Possesses an understanding of technological trends and uses this knowledge to bring solutions to business units supported to enhance the enterprise's competitive edge. May make recommendations for buy versus build decision. May require a bachelor's or master's degree in a related area and 7+ years of experience in the field or in a related area.

Specific Project Role and Job Functions:

The principal duties of this position are to develop and maintain business requirements with associated artifacts such as requirements plans, process flows, and other models as needed.

Daily work will concentrate on these work streams:
• Member
• Provider
• Claims
• Prior Authorization
• Finance

These work streams will support the following modules for RMMIS:
• Business Intelligence System
• Administrative Services Organization (ASO) for Fee for Service (FFS) claims
• Pharmacy Benefits Administrator (PBA)
• Dental Administrative Services Organization (DASO)
• Accounting and Finance
• Third Party Liability (TPL)
• System Integration and Operations (SIOPS)
• Technology Framework (Integration Hub, Portal and Enterprise Data Services)
• RMMIS Program Management

Specific duties include, but are not limited to:
• Plan, elicit, capture, analyze and validate business, functional and technical requirements.
• Facilitate requirements elicitation sessions and walkthroughs with business and IT resources.
• Collaborate with departments to identify, document and communicate business needs and provide solutions.
• Develop business rules via interviews, translation of governing documents and other means.
• Conduct JAD Sessions with Product Owners
• Partner with business owners on requirements development and project collaboration
• Assist other team members in performing business rules, requirements, and modeling duties.
• Research business rules, requirements, and models.
• Use case development
• Requirements traceability


• 8+ years' experience in government IT projects as a business analyst or related duties
• 6+ years' experience eliciting, mining, and documenting business rules
• General Subject Matter Expertise as it relates to Medicaid or other healthcare insurance experience (project or operations)
• Firm understanding of health care payer business process
• Strong understanding of business modeling techniques
• Integrated healthcare delivery from member enrollment though to claims payment
• Business operations experience in member enrollment though to claims payment
• Commercial and Medicaid experience preferable
• Ability to effectively communicate to executive management, line management, project management, and team members.
• Experience and ability to obtain business rules and requirements information by interviewing business personnel and by mining laws, regulations, and policy documents.
• Superb written and oral communications skills, including the ability to write requirements and Use Cases. Very Strong proficiency in English is required


• MMIS experience (project or operations)
• Ability to write and understand business and functional requirements
• Strong knowledge of formal business rules methodologies

Bachelor's degree in a technical, business, or healthcare field.

None required.
Category Name Required Importance Level Last Used Experience
Administrative Verbal Communication Skills Yes 1 Lead Currently Using 6 + Years
Administrative Written Communication Skills Yes 2 Lead Currently Using 6 + Years
Documentation/Language Business Process Modeling (BPM) Yes 2 Advanced Within 1 Year 2 - 4 Years
Education BA Degree- Technical, Business, or Healthcare field Yes 1 Lead Within 10 Years 4 - 6 Years
Miscellaneous experience in government IT projects as a business analyst or related duties Yes 1 Lead Currently Using 6 + Years
Miscellaneous Interpret business process and business data models Yes 3 Advanced Within 1 Year 2 - 4 Years
MMIS - Medicaid Management Informaiton System Commercial healthcare Yes 2 Advanced Within 1 Year 2 - 4 Years
MMIS - Medicaid Management Informaiton System Healthcare Insurance - Business Operations Yes 3 Advanced Within 2 Years 2 - 4 Years
MMIS - Medicaid Management Informaiton System IT Healthcare Systems Yes 1 Advanced Currently Using 6 + Years
Program Management - RUP methodology Eliciting, mining, and documenting business rules, processes Yes 1 Expert Currently Using 6 + Years