Business Analyst III- Medicaid Overpayment Recovery

Elevance Health•Tampa, FL

1d•$73,600 - $110,400•Hybrid

About The Position

The Business Analyst III is responsible for leading complex data analysis and mining efforts using claims data and coding methodologies (CPT, HCPCS, DRG, ICD-9, ICD-10) to identify overpayment recovery opportunities, validate findings, and complete supporting documentation. This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Requirements

Requires a BA/BS and minimum of 5 years business analysis experience; or any combination of education and experience which would provide an equivalent background.
5+ years of experience with data analysis, claims processing, provider billing, FWA investigations, cost containment, Medicare, Medicaid, MMP and/or MedSupp plans
Medical coding experience - CPT, HCPCS, ICD-9/10 coding

Nice To Haves

Healthcare business analysis experience
Experience in using Excel, Facets and MACESS
Medical billing and/or claims processing experience is preferred
CPC or applicable professional designation a plus

Responsibilities

Collaborate with internal business partners to gather requirements, lead stakeholder discussions, research Medicare and Medicaid reimbursement guidelines, and request or execute data queries to support recovery initiatives and business decisions.
Drive continuous process improvements by submitting enhancement requests for recovery projects and reporting tools, coordinating deliverables across stakeholders, and ensuring timely completion of project milestones and business objectives.
Analyzes complex end user needs to determine optimal means of meeting those needs.
Determines specific business application software requirements to address complex business needs.
Develops project plans and identifies and coordinates resources, involving those outside the unit.
Works with programming staff to ensure requirements will be incorporated into system design and testing.
Acts as a resource to users of the software to address questions/issues.
May provide direction and guidance to team members and serves as an expert for the team.