Senior Business Analyst

Position Overview

We are seeking a Senior Business Analyst to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.

In this role, the Senior Business Analyst in Health Care Services plays a pivotal part in bridging the gap between clinical operations and technology solutions to enhance member care and organizational efficiency. You will analyze complex business processes, identify areas for improvement, and design effective strategies that align with healthcare regulations and standards. Working collaboratively with clinical staff, IT professionals, and management, you will gather requirements and translate them into actionable project plans while driving data-driven decision-making and innovative healthcare solutions.

Key Responsibilities

• Maintain data integrity of provider set-ups and reimbursement configurations, including timely updates and troubleshooting.
• Load and implement practitioner, hospital, and ancillary contracts into the claims system, including amendments and claims testing.
• Program and maintain pricing setups based on contract specifications across various care settings (e.g., inpatient, outpatient, ER).
• Participate in client implementations, conversions, and internal/external meetings to support operational needs.
• Create documentation for workflows and policies and mentor staff on complex contract configurations.

Required Qualifications

• Associate's degree in Business Administration, Health Informatics, or a related field.
• At least 4 years of experience as a Business Analyst within the healthcare industry.
• Proficient knowledge of UB04 / CMS-1500 claim adjudication process, including Medicare and Medicaid reimbursement methodologies (i.e. Per Diem, PPS, FFS, APG, Capitation, etc.).
• Good understanding of claim adjudication processes including ICD, CPT, HCPCS.
• Strong proficiency in business analysis tools and methodologies, including requirements gathering and process mapping.
• Relevant experience may substitute for the educational requirement on a year-for-year basis.

Preferred Qualifications

• Bachelor's degree in Health Administration, Public Health, or a related discipline.
• Certification such as Certified Business Analysis Professional (CBAP) or Certified Healthcare Business Analyst (CHBA).
• Experience with Electronic Health Record (EHR) systems and healthcare data analytics platforms.
• Knowledge of healthcare quality improvement frameworks and member safety standards.
• Experience working in agile project environments.