Payment Integrity Business Analyst Senior

AmeriHealth Caritas is a mission-driven organization focused on delivering comprehensive healthcare solutions. The Payment Integrity Business Analyst Senior is responsible for supporting initiatives that drive accuracy and operational integrity through data analysis and business process improvement, collaborating with cross-functional teams to support project implementations and ensure compliance with regulatory standards.

Responsibilities:

• Documents and maintains detailed business requirements and payment integrity workflows
• Collaborates with team members and stakeholders to identify business needs and business requirements
• Conducts root cause analysis and makes recommendations for improvements. Presents analysis, ideas, and positions in writing in a clear and convincing manner
• Support the development and management of provider communications, training materials, and policy updates
• Supports the design, development and implementation of new /changed business processes and procedures utilizing proven process improvement methodologies
• Monitors regulatory and policy changes to ensure payment integrity strategies remain compliant
• Assists in pre-RFP and RFP work. Represents Payment Integrity at Corporate RFP meetings. Serves as a technical resource for functional areas in responding to RFPs (identifying standard or historical responses) and coordinates responses with other departments, as necessary. Works collaboratively with functional areas to ensure proposed RFP responses align with current enterprise standards and guidelines and provides feedback when appropriate. Reviews the final version of draft responses submitted for accuracy and usability prior to submission to Management for review
• Collaborates with cross-functional teams to support project execution
• Monitors project activities to ensure the quality and timeliness of processes as well as ensuring adherence to all company goals and initiatives
• Supports new business initiatives/expansions to ensure operational readiness. Prepare for and facilitating team meetings to review, refine and finalize deliverables as applicable
• Develops and maintains reports to track activities including readiness reviews, audits, and RFPs
• Supports SharePoint Site maintenance to support future initiatives and provides data upon request in a useable format. Updates site to include new business standard documents, workflows, and processes

Requirements:

• Bachelor's Degree
• At least two (2)+ years of experience in healthcare payment integrity or healthcare operations
• At least three (3)+ years of experience in a Business Analyst role
• Strong analytical skills, adept in data analysis and data presentation
• Proficient working knowledge of Microsoft Office Suite, including Excel, SharePoint Online, PowerPoint, Teams, Word, and Tableau
• Ability to work independently and collaboratively to manage multiple projects and tasks to completion
• Knowledge of provider reimbursement methodologies, healthcare regulations and audit practices
• Ability to present information in a clear and concise manner, both written and verbal
• Attention to detail with the ability to source data and synthesize solutions to connect people, processes, and technology
• Previous experience working in healthcare preferred
• Experience with RFP processes and implementation project support is highly desirable