CA, CO, CT, GA, IN, KY, ME, MO, NH, NV, NY, OH, VA, WI – Telecommute
WGS Business Analyst II or III
Indiana, United States; Georgia, United States; Wisconsin, United States; Missouri, United States; Colorado, United States; Connecticut, United States; Virginia, United States; California, United States; Maine, United States; New Hampshire, United States; Nevada, United States; New York, United States; Ohio, United States; Kentucky, United States
Your Talent. Our Vision.At Anthem Blue Cross and Blue Shield, a proud member of the Anthem, Inc. family of companies, it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care. This is an exceptional opportunity to do innovative work that means more to you and those we serve.
This position will allow remote within any of the following states:
CA, CT, CO, GA, IN, KY, ME, MO, NH, NV, NY, OH, VA or WI
The Business Analyst is responsible for translating moderately complex and varied business needs into business cases or business requirements document (BRD) to create data mining queries that will contribute to cost of care savings and total program savings.
Primary duties may include, but are not limited to:
Business Analyst II
Assessing overpayment opportunity by reviewing low to high volume claim samples
Accessing provider contracts, company claims policy and coding guidelines to support recovery opportunity
Partnering closely with recovery data analysis to create queries that will identify overpayment identifications for recovery.
Interacting with query developers, business owners, and business consultants
Managing and prioritizing work assignments based on business needs
Business Analyst III
All duties of the Business Analyst II in addition to:
Effectively research leads to identify additional recovery savings opportunities.
Identifies and analyzes complex overpayment recovery needs to determine optimal means of meeting those needs.
Determines specific business requirements to address complex business needs.
Develops Business Requirement Documentation and coordinates UAT, involving those outside the unit.
Works with Query Developers to ensure requirements will be incorporated into Recovery query design and testing.
May provide direction and guidance to team members and serves as an expert for the team.
Identify process improvement opportunities that result in increased savings
Serve as a liaison between the data science, recovery adjustments and other business partners
*Level will be determined by skills and experience of selected candidate*
Business Analyst II – Requires BS/BA degree or equivalent experience, 3-5 years related recovery analysis experience or any combination of education and experience which would provide an equivalent background. This position is mid-level analyst with more recovery experience. WGS claims processing and recovery experience. In-depth knowledge of claims processing, recovery policies and procedures is required. Ability to review, understand and apply reimbursement logic to claims based on Provider Contractual language. In-depth knowledge of reimbursement factors applied to claims. System configuration, contract set up knowledge is preferred. Business Objects knowledge is preferred. Contraxx knowledge is preferred. Micro strategy understanding is helpful.
Business Analyst III – Requires a BS/BA degree, 5-7 years of business analysis experience that includes knowledge of systems capabilities and business operations; or any combination of education and experienced, which would provide an equivalent background. In-depth knowledge of recovery policies and procedures is required. Ability to review, understand and apply reimbursement logic to claims based on Provider Contractual language. In-depth knowledge of rei…
Business Consultant , Insurance , Insurance Claims , Analyst
CA, CO, CT, GA, IN, KY, ME, MO, NH, NV, NY, OH, VA, WI