Business Analyst II - Payment Integrity Datamining

Elevance Health•Tampa, FL

23h•$64,764 - $97,146•Hybrid

About The Position

Carelon, a proud member of the Elevance Health family of companies, is a healthcare services organization that takes a whole-health approach to making care more integrated, personalized, and affordable. We put people at the center—connecting physical, behavioral, social, and pharmacy services, along with clinical expertise, research, operations, and advanced technology to help care work better, together. Among us are care providers, engineers, data scientists, and other dedicated professionals determined to recover, eliminate and prevent unnecessary medical-expense spending. The Business Analyst II will be responsible for translating basic business needs into application software requirements.

Requirements

Requires a BA/BS and minimum of 3 years related business analysis experience, or any combination of education and experience, which would provide an equivalent background.

Nice To Haves

Familiarity with healthcare payer systems, claim lifecycle, and reimbursement methodologies, along with a basic understanding of medical billing guidelines and regulations.
Exposure to medical coding systems (ICD, CPT, HCPCS) is a plus.
Strong analytical abilities to review claim data and identify overpayment trends, along with a problem-solving mindset for troubleshooting issues and testing solutions.
Ability to extract insights from data to support claim validation and recovery accuracy.
Strong writing skills for provider communications and validation instructions, and the ability to create and maintain policies, manuals, and contracts to support transparency.
Clear communication with stakeholders to address workflow inquiries.
Capacity to adapt quickly to evolving tasks, new tools, and process improvements, with the ability to multitask.
Self-starter, proactive in supporting recovery operations.
Work effectively as a liaison between external business partners, vendors, and internal teams.
Contribute to a culture of continuous improvement within Payment Integrity.
Knowledge of systems capabilities and business operations is strongly preferred
Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills

Responsibilities

Analyzes business needs to determine optimal means of meeting those needs
Determines specific business application software requirements to address specific business needs
Works with programming staff to ensure requirements will be incorporated into system design and testing
Acts as liaison with users of the software to address questions/issues