Sr. Healthcare Business Analyst
Core
Analyze claims data, maintain EDI mapping (835/837), and develop reports to improve auto-adjudication accuracy and payment integrity for Medicaid/Medicare patients.
Role type
Senior Healthcare Business Analyst (Claims Operations)
Builds
Claims data pipelines, EDI remittance files, and operational reports
Domain
Healthcare / Insurance Claims
Required skills
Advanced Microsoft Excel, SSRS report development, Microsoft SQL Server, Data pipeline/ETL understanding, EDI file structures and mapping, Data analysis
Preferred skills
Power BI, Health plan experience
Technologies
Data Warehouse, ETL, Excel, SSRS, SQL, Power BI, EDI
Responsibilities
Review claims system configuration to improve auto-adjudication accuracy; Develop and maintain data dictionaries; Create and maintain internal/external reports using SSRS and Excel; Develop and maintain the 835 remittance process; Maintain 837 EDI mapping; Prepare data loads and validate benefit rules using SQL and Excel; Extract and analyze large datasets to identify trends and discrepancies; Investigate and resolve configuration-related claim errors; Maintain data warehouse accuracy; Write complex ad hoc reports in SQL; Recommend process improvements for efficiency and data quality.
Seniority
Senior, hands-on IC