Sr. Business Analyst (Credentialing Experience Required) - REMOTE
Remote · United States
Job Summary
Senior-level business analyst responsible for intake and interpretation of regulatory and functional requirements related to coverage, reimbursement, and processing to support systems solutions development and maintenance. This role coordinates with stakeholders and subject matter experts on partnering teams and supports governance committees where applicable. Develops and maintains requirement documents for coverage, reimbursement and system changes in alignment to regulatory baseline requirements. Monitors regulatory updates and collaborates with operational leaders to identify process improvements and cost-saving opportunities. Leads coordinated development and ongoing management/interpretation review processes with key partner organizations, translating customer business needs into application and operational requirements. Communicates requirement interpretations and changes to health plans/product teams and impacted corporate areas for alignment and traceability. Codifies requirements for system configuration where applicable and provides support for interpretation inconsistencies. Contributes to development of requirement solution standards and best practices while proposing improvements to apply requirements across states and products. Self-organized reporting to keep health plans/product teams and leadership informed of work efforts and impact for prospective or retrospective requirement changes. Coordinates with relevant teams for analysis, impact and implementation of changes affecting the product. Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes. Remote-friendly, with ability to work across time zones.
Required Qualifications
- At least 4 years of experience in managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience.
- Policy/government legislative review knowledge
- Strong analytical and problem-solving skills
- Familiarity with administration systems
- Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams
- Previous success in a dynamic and autonomous work environment
- Knowledge and experience with federal regulatory policy resources including CMS and ACA.
- Medical Coding certification.
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