Job Description

Position: Healthcare Business Analyst (Claims and Pre-Authorization)

Location: Parsippany-Troy Hills, NJ, USA(On-Site)

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.

Regards,

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Manoj

Derex Technologies INC

Contact : 973-834-5005 Ext 206

Additional Information

All your information will be kept confidential according to EEO guidelines.