Empowering data-driven healthcare for payers, providers, pharmacies, and life sciences organizations.
Senior Business Analyst
Location
United States
Posted
8 days ago
Salary
0
Seniority
Senior
No structured requirement data.
Job Description
Senior Business Analyst
Inovalon
Role Description We are seeking a highly experienced Senior Business Analyst with deep expertise in specialty/infusion pharmacy, medical billing, and financial reconciliation to support enterprise SaaS implementations. This role serves as a critical liaison between clients, operations, product, and engineering teams to define business requirements, design future-state workflows, and ensure successful delivery of Revenue Cycle Management (RCM) solutions. The ideal candidate brings strong domain knowledge in pharmacy billing, claims adjudication, payment posting, and reconciliation, and plays a key role across the full client lifecycle—from pre-sales through implementation and post-go-live optimization. Key Responsibilities - Delivery & Strategic Execution - Lead complex and enterprise-wide implementations with multiple integrated workstreams. - Own RCM functional track deliverables, ensuring alignment across stakeholders. - Define governance standards, implementation plans, and risk mitigation strategies. - Drive future-state workflow design across pharmacy operations and revenue cycle processes. - Manage release coordination, dependencies, and cross-functional execution. - Pharmacy Billing & Revenue Cycle Expertise - Serve as Subject Matter Expert (SME) in: - Medical and pharmacy billing (specialty and infusion). - Claims lifecycle management (submission, adjudication, reversals, rebilling). - Payment posting, ERA (835), and financial reconciliation. - Optimize workflows to improve: - Clean claim rate and first-pass yield. - Denial management and resolution. - Days in Accounts Receivable (A/R). - Net collections and revenue leakage prevention. - Analyze and resolve billing discrepancies including underpayments, overpayments, and unapplied cash. - Ensure alignment between pharmacy systems, billing platforms, clearinghouses, and financial systems. - Client Engagement & Product Collaboration - Work closely with clients to gather and define RCM and operational requirements. - Translate client needs into business and system requirements for product development. - Provide business case justification for product enhancements. - Participate across the full lifecycle: - Request for Proposal (RFP) responses and product demos. - Implementation, testing, and go-live. - Post-production support and optimization. - Partner with Product Managers on roadmap and knowledge sharing. - Requirements & Process Analysis - Elicit, document, and manage business and system requirements (BRDs, design documents). - Develop process workflows using tools such as Visio. - Analyze current systems and identify improvement opportunities. - Assess impacts of proposed solutions across systems, workflows, and stakeholders. - Technical & Data Capability - Work within SaaS environments utilizing Agile/Scrum and full SDLC practices. - Support system configuration and ensure alignment with business requirements. - Define data requirements and support reporting and reconciliation processes. - Utilize tools such as SQL and Crystal Reports for data validation and analysis. - Support integrations across APIs, FHIR/HL7, claims (NCPDP/837), and remittance (835). - Validation & Quality Assurance - Lead User Acceptance Testing (UAT) strategy, planning, and execution. - Participate in system validation prior to release. - Triage and resolve escalated defects in collaboration with QA and engineering. - Ensure delivered solutions meet client, operational, and financial expectations. - Stakeholder & Leadership Responsibilities - Act as a trusted advisor to clients and internal leadership. - Lead cross-functional discussions and align business and technical teams. - Support training initiatives and knowledge transfer. - Mentor junior analysts and promote BA best practices. - Operational Excellence & Business Impact - Drive improvements in onboarding, billing accuracy, and operational efficiency. - Support standardization, scalability, and adoption of solutions. - Compliance & Governance - Ensure adherence to HIPAA, DEA, State Board, and regulatory requirements. - Maintain compliance with Inovalon policies and procedures. - Support audit readiness and financial accuracy. Qualifications - Bachelor’s Degree in Healthcare, IT, Business, or related field (or equivalent experience). - 5+ years of Business Analysis experience in healthcare or SaaS. - 2+ years of experience in medical billing and financial reconciliation. - Experience in specialty or infusion pharmacy environments preferred. - Strong background in Revenue Cycle Management (RCM). Requirements - Primarily sedentary role involving extended periods of sitting and computer use. - Occasional lifting (up to 10 pounds). - Ability to work in a fast-paced, dynamic environment. - Travel for this position will include up to 10%.
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