Senior Business Analyst – Pharmacy (RCM, Billing & Financial Reconciliation)

Inovalon•Canonsburg, PA

2d•$109,000 - $143,600•Onsite

About The Position

We are seeking a highly experienced Senior Business Analyst with deep expertise in specialty/infusion pharmacy, medical billing, and financial reconciliation to support enterprise SaaS implementations. This role serves as a critical liaison between clients, operations, product, and engineering teams to define business requirements, design future-state workflows, and ensure successful delivery of Revenue Cycle Management (RCM) solutions. The ideal candidate brings strong domain knowledge in pharmacy billing, claims adjudication, payment posting, and reconciliation, and plays a key role across the full client lifecycle—from pre-sales through implementation and post-go-live optimization.

Requirements

Bachelor’s Degree in Healthcare, IT, Business, or related field (or equivalent experience)
5+ years of Business Analysis experience in healthcare or SaaS
2+ years of experience in medical billing and financial reconciliation
Experience in specialty or infusion pharmacy environments preferred
Strong background in Revenue Cycle Management (RCM)

Responsibilities

Lead complex and enterprise-wide implementations with multiple integrated workstreams
Own RCM functional track deliverables, ensuring alignment across stakeholders
Define governance standards, implementation plans, and risk mitigation strategies
Drive future-state workflow design across pharmacy operations and revenue cycle processes
Manage release coordination, dependencies, and cross-functional execution
Serve as Subject Matter Expert (SME) in: Medical and pharmacy billing (specialty and infusion), Claims lifecycle management (submission, adjudication, reversals, rebilling), Payment posting, ERA (835), and financial reconciliation
Optimize workflows to improve: Clean claim rate and first-pass yield, Denial management and resolution, Days in Accounts Receivable (A/R), Net collections and revenue leakage prevention
Analyze and resolve billing discrepancies including underpayments, overpayments, and unapplied cash
Ensure alignment between pharmacy systems, billing platforms, clearinghouses, and financial systems
Work closely with clients to gather and define RCM and operational requirements
Translate client needs into business and system requirements for product development
Provide business case justification for product enhancements
Participate across the full lifecycle: Request for Proposal (RFP) responses and product demos, Implementation, testing, and go-live, Post-production support and optimization
Partner with Product Managers on roadmap and knowledge sharing
Elicit, document, and manage business and system requirements (BRDs, design documents)
Develop process workflows using tools such as Visio
Analyze current systems and identify improvement opportunities
Assess impacts of proposed solutions across systems, workflows, and stakeholders
Work within SaaS environments utilizing Agile/Scrum and full SDLC practices
Support system configuration and ensure alignment with business requirements
Define data requirements and support reporting and reconciliation processes
Utilize tools such as SQL and Crystal Reports for data validation and analysis
Support integrations across APIs, FHIR/HL7, claims (NCPDP/837), and remittance (835)
Lead User Acceptance Testing (UAT) strategy, planning, and execution
Participate in system validation prior to release
Triage and resolve escalated defects in collaboration with QA and engineering
Ensure delivered solutions meet client, operational, and financial expectations
Act as a trusted advisor to clients and internal leadership
Lead cross-functional discussions and align business and technical teams
Support training initiatives and knowledge transfer
Mentor junior analysts and promote BA best practices
Drive improvements in onboarding, billing accuracy, and operational efficiency
Support standardization, scalability, and adoption of solutions
Ensure adherence to HIPAA, DEA, State Board, and regulatory requirements
Maintain compliance with Inovalon policies and procedures
Support audit readiness and financial accuracy