Pega Healthcare Claims System AnalystRemoteMAX SUPPLIER BILL RATE: $73/HRRequired Skills: 1. Healthcare Claims Processing 2. Pega 3. Facets (Claims, Membership, Billing, Provider) 4. EDI 837/835 5. Business AnalysisJob Description:• Gather, analyze, and document business and system requirements for healthcare claims processing initiatives.• Work closely with business stakeholders, product owners, developers, and QA teams to ensure requirements are accurately defined and implemented.• Analyze healthcare claims workflows including claims intake, adjudication, adjustments, provider reimbursement, and payment processing.• Work with Facets modules including Claims, Membership, Billing, and Provider to support end-to-end claims lifecycle management.• Translate business requirements into functional specifications, user stories, process flows, and acceptance criteria.• Analyze member, provider, claims, benefits, and authorization data to support operational and system enhancement initiatives.• Support Agile development activities including backlog grooming, sprint planning, testing, defect triage, and release activities.• Participate in requirements workshops, stakeholder discussions, and solution design reviews.• Support User Acceptance Testing (UAT), validate business requirements, and assist with production issue analysis.• Ensure healthcare claims requirements and workflows align with HIPAA and EDI 837/835 transaction standards.
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At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws.This position's pay range is $7.25/hr - $80.00/hr.
