Business Analyst

About the role

The successful candidate will analyze utilization trends, claims data, and pharmacy data to identify cost-containment opportunities. They will document, review, and enhance Utilization Management (UM) processes, including intake, concurrent review, and appeals. Additionally, they will define business requirements for IT solutions and conduct User Acceptance Testing (UAT).

Responsibilities

• Analyze utilization trends, claims data, and pharmacy data to identify cost-containment opportunities.
• Document, review, and enhance Utilization Management (UM) processes (intake, concurrent review, appeals).
• Define business requirements for IT solutions and conduct User Acceptance Testing (UAT) for UM software.
• Ensure all UM processes comply with state/federal regulations and accreditation standards.
• Act as a liaison between clinical staff (nurses, medical directors) and IT/leadership.

Requirements

• 3-5+ years of experience in Utilization Management (UM), care management, or managed care settings.
• Strong SQL skills, experience with data visualization tools (e.g., Tableau, Power BI), and electronic health records (EHR/EMR).
• Deep understanding of healthcare coding (ICD-10, CPT), claims, and insurance regulations.
• Bachelor’s degree in Healthcare Administration, Nursing, or a related field.
• RN or LPN license is highly preferred for clinical data interpretation.

Qualifications

• Strong analytical and problem-solving skills.
• Excellent communication and interpersonal skills.
• Ability to work independently and as part of a team.

Skills

• Data analysis and interpretation.
• SQL and data visualization tools.
• Healthcare coding and regulations.
• Electronic health records (EHR/EMR).
• Project management and user acceptance testing.

Benefits

• Opportunity to work with a global technology leader.
• Engagement in critical healthcare industry projects.
• Contribution to optimizing healthcare processes and systems.

Pay

TBD

Schedule

TBD

Benefits

• Flexible work schedule.
• Competitive compensation package.
• Professional development opportunities.
• Employee wellness programs.

Application

Apply via Haystack today!