Business Analyst (Payment Integrity) - 100% Remote

Business Analyst :

• Help create and define best practices for ePMO
• Develop requirements (BRD) for common payment integrity data sets (including eligibility, provider, and claims)
• Create data flows as needed per project
• Support development of key projects under Payment Integrity Program
• Work with multiple Vendors to identify requirements for data, files, frequency, integration, testing and implementation
• Collaborate with internal IT Teams to review requirements, answer questions, and resolve any open issues
• Create and update business requirements matrix documentation

Required skills:

• Experience documenting data exchange requirements for health plans and vendor integrations
• 5 years of BA experience
• 1-2 years process improvement with focus on creating templates and best practices
• 2-3 years Healthcare Payer industry experience
• 2-3 years working with multiple vendors to identify data and reporting requirements for integration

Preferred skills:

• In depth knowledge of Payment Integrity Edits (Pre Pay and Post Pay)
• Creating requirements for common Payment Integrity data sets