The Business Analyst III is responsible for serving as the liaison between the business and IT in translating complex business needs into application software.
How will you make an impact :
- Analyzes complex end user needs to determine optimal means of meeting those needs.
- Develops project plans and identifies and coordinates resources, involving those outside the unit.
- Works with programming staff to ensure requirements will be incorporated into system design and testing.
- Manages 834 (eligibility file), 837 (encounter data file) and all other file transfer processes for all dental, vision and non-emergent transportation vendors in the GBD markets.
- Develops specs and implements special projects, supports Regulatory Oversight Analysts, and also performs maintenance and support of three separate SharePoint sites.
- Performs QA checks, reconciles and validates encounter data.
- Analyzes and audits files submitted by vendors (i.e. cash disbursement journal/837/claims detail file) to determine if services were appropriate and payment to vendor is warranted.
- Works directly with vendors to resolve any open data issues and/or discrepancies found during the performance of a periodic reconciliation.
- Performs prepayment review to ensure vendors are billing according to state specific requirements, as well as fee schedule audits
- Assists in the development of an eligibility verification for vendor files.
- Develops audit protocols and processes for use in the performance of various audit responsibilities.
- Requires a BS/BA degree; 5-7 years of business analysis experience that includes knowledge of systems capabilities and business operations; any combination of education and experience, which would provide an equivalent background.
Preferred skills, Capabilities and Experiences
- Familiar with EDI 834 and 837 testing and analysis
- Ability to run complex SQL queries
- some Knowledge Management experience preferred
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact email@example.com for assistance.