Business Analyst IISupports the Payment Integrity line of businessLocation: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles from one of our posted Elevance Health locations.Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending.The Business Analyst II works within the Cost Containment Unit (CCU) which is an operational unit that leads the effort to identify, analyze, validate and avoid medical overpayments. Cost Containment’s goal is to deliver measurable cost savings through expense recovery and cost avoidance. This will include translating basic business needs into application software requirements.How you will make an impact:
Analyzes business needs to determine optimal means of meeting those needs.
Acts as liaison with users of the software to address questions/issues.
Research all resource documents and web-sites.
Document findings that support the concept.
Request and/or run queries as needed to retrieve data.
Meet with various business partners as needed.
Submit enhancement request for database updates.
Ensures proper review of the Forager Pipeline and Analyst reports.
Commit to deliverables and maintain timely turnaround times.
Determines specific business application software requirements to address specific business needs.
Works with programming staff to ensure requirements will be incorporated into system design and testing.
Perform data mining utilizing CPT, HCPCS, DRG, ICD-9, ICD-10, etc., to identify recovery opportunities.
Validate overpayments, complete Approach document and forward necessary files and documents for CCU Load
Minimum Requirements:
Requires a BA/BS and minimum of 3 years related business analysis experience, or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences :
Healthcare business analysis experience preferred.
Experience in using Facets, SQL and MACESS highly preferred.
Medical billing and/or claims processing experience is preferred.
2+ years of experience with data analysis, claims processing, provider billing, FWA investigations, cost containment, Medicare, Medicaid, MMP and/or MedSupp plans strongly preferred.
Medical coding experience - CPT, HCPCS, ICD-9/10 coding preferred.
CPC or applicable professional designation preferred.
Proficient of Microsoft Office products, most notably expertise in Excel for reporting, Word, PowerPoint, Teams, and Outlook strongly preferred.
If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a sensitive position work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.For candidates working in person or remotely in the below location, the salary range for this specific position is $60,984 to $91,476.Locations: MarylandIn addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws .
The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.Who We AreElevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.How We WorkAt Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [email protected] for assistance.