Business Analyst

Role Overview

• Supports tracking and reconciliation of case reviews/disputes, ensuring timely and accurate processing and monitoring of the work queues and correspondence.
• Assists in developing and refining workflows, templates, and documentation tools that support the review process and reporting functions.
• Conducts research to ensure practices are compliant with the Federal IDR process.
• Perform research and analysis for any disputes or discrepancies with parties regarding disputes.
• Audit and review the IDR process to ensure data accuracy.
• Use critical thinking to define problems, identify root causes, and recommend solutions.
• Reconciles and updates portals to ensure accurate entry of dispute information.
• Stay up-to-date on CMS NSA Guidelines and adapt to changes in the No Surprise Act.
• Adhere to all relevant compliance regulations (Health Insurance Portability and Accountability Act, Federal Information Security Management Act, URAC, Centers for Medicare & Medicaid Services, Federal Acquisition Regulation (FAR)).
• Complete other duties as assigned.

Requirements

• High School Diploma or general education degree (GED) and 1 to 3 years’ related experience and/or training; or equivalent combination of education and experience.
• Associate’s degree in healthcare or business preferred.
• 1-3 years’ experience working with medical billing, claims, appeals, coding, customer service, insurance verification, and medical records, with financial and revenue cycle analysis preferred.
• Strong analytical and organizational abilities; skilled at managing multiple tasks while maintaining accuracy.
• Effective written and verbal communication; able to convey information clearly and professionally.
• Demonstrated ability to track, analyze, and interpret data.
• Ability to work independently with minimal direction.
• Proficient in Microsoft Office Suite, especially Excel (pivot tables, formulas, data analysis), Word, and PowerPoint.

Benefits

• Commence is an equal employment opportunity employer.
• Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.