Analyst, Business
Remote · United States
Job Summary
Analyst, Business role translating regulatory and business requirements into actionable edit configurations within pre-pay platforms; leads interpretation of state, CMS, and health plan requirements, owns full lifecycle of edit development from intake to deployment and maintenance; partners with IT, vendors, and cross-functional teams; drives governance processes, traceability from requirement to outcome, and interface with health plans, product teams, and core functional areas. Responsibilities include monitoring regulatory sources, performing root-cause analysis on logic gaps and defects, and ensuring alignment with coverage, reimbursement, and processing requirements. Requires 3+ years in healthcare/payments, ability to interpret rule-based logic, strong communication skills, and remote-work capability.
Required Qualifications
- 3+ years of experience in healthcare, managed care, or Payment Integrity
- strong knowledge of claims adjudication, claims editing, reimbursement logic
- ability to interpret, review, and validate rule-based logic or configuration outputs
- synthesize complex requirements into clear business and configuration direction
- strong analytical, problem-solving, and critical-thinking skills
- experience leading requirement discussions and cross-functional collaboration
- ability to work independently in a remote environment
- proficiency with Microsoft Office tools
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