Business Analyst

Job Summary

Interpreting regulatory and business requirements, the full-time Business Analyst will translate these into actionable edit configurations within pre-pay platforms while collaborating with Payment Integrity, Health Plans, IT, vendors, and SMEs in a remote environment.

Key responsibilities

• Lead the interpretation of state, CMS, and health plan requirements into business rules and edit logic
• Own the full lifecycle of edit development, including requirements intake, configuration, validation, and maintenance
• Perform advanced root cause analysis on logic gaps and configuration defects to ensure alignment with regulatory requirements

Required qualifications

• 3+ years of experience in healthcare, managed care, or Payment Integrity with knowledge of claims adjudication and editing
• Proven ability to interpret and validate rule-based logic and synthesize complex requirements
• Strong analytical skills with experience managing multiple states and aggressive timelines
• Effective communicator with experience leading requirement discussions and influencing cross-functional teams
• Ability to work independently in a remote environment and proficiently use Microsoft Office tools