Business Analyst (Claims), Senior

About the role

Acentra Health is seeking a Senior Business Analyst (Claims) to join our dynamic team. This role involves logical design and functional behavior of solutions involving complex information systems, including Provider Enrollment, Claims, and Prior Authorization.

Responsibilities

• Elicit requirements working with customers and stakeholders.
• Demonstrate in-depth knowledge of business and technical solutioning relating to Core Claims to ensure high quality.
• Work with customers on presenting technical solutions for complex business functionalities.
• Possess unwavering commitment to customer service and operational excellence.
• Provide customer support through leading client demos and presentations.
• Prioritize and schedule work assignments based on the project plan, handling multiple tasks across project phases.
• Create and modify Business Process Models.
• Understand the overall system architecture and cross-functional integration.
• Demonstrate in-depth knowledge of business analysis relating to Provider Enrollment, Maintenance and Screening to ensure high quality.
• Use cases, workflow diagrams, and gap analysis to create and modify requirements documents and design specifications.
• Analyze user requirements and client business needs, leveraging expert opinion and expertise.
• Act as the requirements subject matter expert and support requirements change management.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

Qualifications

• Bachelor's’ degree or equivalent experience in lieu of a degree (minimum 5+ years of business analysis experience in Healthcare).
• Strong knowledge of Medicare / Medicaid Management Information System around Core Claims and/or Provider Management and Enrollment System experience.
• Minimum 5 years of experience on large complex projects and domain knowledge of Medicare healthcare vertical.
• Strong knowledge in Medicare policies and guidelines.
• Strong knowledge in claims adjudication and validations.
• Strong knowledge in Medicare Reimbursement methodologies.
• Excellent Business Analysis Process (SDLC, documentation procedures) experience.
• Excellent customer relation skills including presentation and meeting facilitation.
• Experience facilitating and running customer facing requirements and design sessions.
• Excellent requirements elicitation and validation skills.
• Strong knowledge and proficiency in SQL, plus high-level of technical and database knowledge.

Preferred Qualifications

• State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.
• We do this through our people. You will have meaningful work that genuinely improves people's lives across the country.
• We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Benefits

• Comprehensive health plans
• Paid time off
• Retail savings
• Corporate wellness
• Education assistance
• Corporate discounts

Pay

USD $95,360.00 - USD $119,200.00 /Yr.