Job Description
Position Summary
We are seeking a Business Analyst to support our growing Payment Integrity (PI) operations. This role will work closely with business stakeholders, product managers, and technical teams to document requirements, analyze healthcare claims data, and support the delivery of solutions that reduce improper payments and improve financial accuracy.
The ideal candidate will have hands-on experience with claims data analysis, requirements documentation (BRDs, FRDs, user stories), and knowledge of payer/provider workflows.
Key Responsibilities
- Elicit, analyze, and document business requirements (BRDs, FRDs, acceptance criteria, process flows).
- Partner with stakeholders to translate business needs into system requirements for PI products (e.g., DRG review, HBA, COB, data mining, IBR).
- Conduct claims data analysis to identify trends, validate audit findings, and support product design.
- Collaborate with IT, QA, and operations teams to ensure requirements are implemented and tested accurately.
- Track and report performance metrics, savings impact, and accuracy rates for PI solutions.
- Stay current on payer policy changes, CMS/NCCI updates, and regulatory guidance relevant to PI.
Qualifications
- Education: Bachelor’s degree in Business, Healthcare Administration, Data Analytics, or related field (or equivalent experience).
- Experience:
- 3+ years as a Business Analyst in healthcare, payer, or PI environment.
- Strong understanding of claims processing (professional, facility, pharmacy) and related transactions (837, 835, COB, EOBs).
- Experience documenting detailed requirements and acceptance criteria.
- Skills:
- Strong analytical and problem-solving abilities.
- Proficiency in SQL/Excel; familiarity with BI tools a plus.
- Excellent communication and stakeholder management skills.
- Ability to manage competing priorities and deliver within deadlines.
Preferred Experience
- Prior work with DRG auditing, HBA, COB, IBR, or edit engine configuration.
- Knowledge of medical coding standards (ICD, CPT, HCPCS).
- Familiarity with payer SIU/FWA operations or subrogation.
- Exposure to Agile methodologies and tools such as Jira/Confluence.
Success Profile
- Detail-oriented, with the ability to bridge business and technical needs effectively.
- Adept at interpreting claims data and turning insights into actionable requirements.
- Collaborative, clear communicator who thrives in cross-functional environments.
- Driven to reduce waste and improve accuracy in the healthcare ecosystem.
