Job Description
Overview:
As a Healthcare Business Analyst specializing in claims processing and pre-authorization, you will play a critical role in optimizing the development of our products. Your expertise will contribute to efficient claims management, accurate pre-authorization decisions, and streamlined processes.
Responsibilities:
- Analyze end-to-end claims workflows, from submission to payment.
- Collaborate with stakeholders (insurers, providers, patients) to identify process improvements.
- Understand how to Ensure compliance with industry standards (e.g., HIPAA)
- Evaluate pre-authorization requests for medical services or procedures.
- Verify medical necessity and adherence to guidelines.
- Facilitate timely approvals by working closely with providers and payers.
- Utilize tools like Excel, SQL, and data visualization platforms.
- Create reports, dashboards, and presentations to communicate insights.
- Monitor performance metrics related to claims and pre-authorization.
- Collaborate with IT teams to enhance products and development of claims processing systems.
- Gather requirements for system upgrades and new features.
- Maintain strong communication with cross-functional business units.
Benefits:
- Competitive salary
- Health insurance coverage
- Retirement plans
- Professional development opportunities
Industry
- IT Services and IT Consulting
Employment Type
Full-time
Edit job description