Business Analyst III- Medicaid Overpayment Recovery
Core
Leading complex data analysis and mining efforts using claims data and coding methodologies to identify Medicaid overpayment recovery opportunities.
Role type
Senior Business Analyst (Healthcare Claims)
Builds
Recovery projects and reporting tools for Medicaid overpayment initiatives
Domain
Healthcare / Insurance / Medicaid
Deliverable
production ML models | product features | dashboards & analysis
Required skills
Data analysis, Claims data mining, CPT/HCPCS/ICD-10 coding, Stakeholder collaboration, Process improvement, Project planning, Software requirements analysis
Preferred skills
Medical billing, Claims processing, FWA investigations, Cost containment, Medical coding, Facets/MACESS tools
Technologies
Excel, Facets, MACESS
Responsibilities
Collaborate with internal business partners to gather requirements and research reimbursement guidelines; Drive continuous process improvements by submitting enhancement requests; Analyze end user needs to determine optimal solutions; Determine specific business application software requirements; Develop project plans and coordinate resources; Work with programming staff to ensure requirements are incorporated into system design.
Seniority
Senior, hands-on IC