Business Analyst, Consultant

About the role

The Clinical Coding team seeks an experienced Business Analyst, Consultant with strong analytical, business, and technical expertise to support complex, cross functional initiatives.

Responsibilities

• Provide highly complex analytical support through the analysis and interpretation of data in support of cross-functional business operations
• Lead the development of annual operating plans, capital budgets and forecasts, and build business cases for new business initiatives (cost/benefit analysis)
• Develop, prepare, and analyze reports with highly complex analysis and data for management review, and presents to various levels of management
• Define business requirements and provide analysis to increase operational efficiency
• Support multiple, highly complex cross-functional projects simultaneously by establishing work plans, managing timelines, and coordinating with internal and external stakeholders
• Manage critical programs including ClaimsXten monthly maintenance, release planning, and defect resolution to ensure accurate and timely claims adjudication
• Translate payment policy, regulatory requirements (e.g., CMS, NCCI), and medical policy intent into system configuration and business rules
• Partner cross-functionally with Payment Integrity, IT, Medical Policy, and Operations teams to design and implement business solutions
• Monitor operational performance and identify risks, gaps, and improvement opportunities to support cost of healthcare (CoHC) outcomes
• Support audit readiness, compliance requirements, and provider dispute resolution through data analysis and documentation

Qualifications

• Requires a bachelor’s degree or equivalent experience
• Requires at least 7 years of prior relevant experience
• Requires deep knowledge of job area typically obtained through advanced education combined with experience
• Requires strong knowledge of business analysis, payment policy, California state mandates and claims operations
• Requires at least 3 years of Payment policies and claims processing or equivalent experience
• Familiarity with provider manuals, CMS/NCCI guidelines, and payment integrity operations
• Knowledge of ClaimsXten or similar claims editing software
• Strong analytical and problem-solving skills with ability to conduct independent research and synthesize findings
• Advanced knowledge and ability to perform process mapping, root-cause analysis, gap analysis and requirements gathering
• Practical knowledge of project management
• Ability to deal with complexity, compressed timelines and shifting priorities
• Proficient with MS Office products, including Word, PowerPoint and Excel. Visio expertise a plus
• Strong interpersonal and verbal and written communication skills
• Agile experience preferred