Business Analyst III- Medicaid Overpayment Recovery

About the role

The Business Analyst III is responsible for leading complex data analysis and mining efforts using claims data and coding methodologies (CPT, HCPCS, DRG, ICD-9, ICD-10) to identify overpayment recovery opportunities, validate findings, and complete supporting documentation.

Responsibilities

• Collaborate with internal business partners to gather requirements, lead stakeholder discussions, research Medicare and Medicaid reimbursement guidelines, and request or execute data queries to support recovery initiatives and business decisions.
• Drive continuous process improvements by submitting enhancement requests for recovery projects and reporting tools, coordinating deliverables across stakeholders, and ensuring timely completion of project milestones and business objectives.
• Analyzes complex end user needs to determine optimal means of meeting those needs.
• Determines specific business application software requirements to address complex business needs.
• Develops project plans and identifies and coordinates resources, involving those outside the unit.
• Works with programming staff to ensure requirements will be incorporated into system design and testing.
• Acts as a resource to users of the software to address questions/issues.
• May provide direction and guidance to team members and serves as an expert for the team.

Requirements

• Requires a BA/BS and minimum of 5 years business analysis experience; or any combination of education and experience which would provide an equivalent background.
• Healthcare business analysis experience
• Experience in using Excel, Facets and MACESS
• Medical billing and/or claims processing experience is preferred
• 5+ years of experience with data analysis, claims processing, provider billing, FWA investigations, cost containment, Medicare, Medicaid, MMP and/or MedSupp plans
• CPT, HCPCS, ICD-9/10 coding experience
• CPC or applicable professional designation a plus

Benefits

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $73,600 to $110,400. Locations: Virginia

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

Pay

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $73,600 to $110,400. Locations: Virginia

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

Schedule

This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.