Location: 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: Maryland
In 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.
