Business Analyst II managing payment integrity recovery requests in healthcare. Collaborating with teams to analyze claims and ensure compliance with health regulations.
Responsibilities
Analyzes business needs to determine optimal means of meeting those needs.
Determines specific business application software requirements to address specific business needs.
Works with programming staff to ensure requirements will be incorporated into system design and testing.
Acts as liaison with users of the software to address questions/issues.
Review and evaluate payment integrity recovery requests from external partners to determine validity and appropriateness.
Requirements
Requires a BA/BS and minimum of 3 years related business analysis experience
2–4 years of experience in healthcare claims analysis, payment integrity, or related field strongly preferred
Proficient in Facets, Macess, and Microsoft Office Suite (Excel, Word, Outlook) preferred
Experience in payment integrity or claims recovery functions within a health insurance or managed care environment strongly preferred
Familiarity with data analysis or query tools (e.g., SQL, Tableau, or similar) preferred.
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