• Combine deep medical coding expertise with strong business analysis capability to support healthcare system operations and implementations • Act as a bridge between operational areas, delivery teams, and client stakeholders, ensuring that coding, billing, and policy requirements are clearly defined, accurately implemented, and well documented • Play a key role in strengthening alignment between functional areas and delivery, translating complex concepts into clear, actionable guidance that supports both system solutions and day-to-day operations for Medicaid programs • Develop and own structured solution artifacts and operational deliverables that define coding, billing, or policy-related changes, driving them end-to-end from initial definition through review, coordination, testing alignment, implementation, and closure • Elicit, document, and manage business, functional, and operational requirements, translating complex medical coding and billing concepts into clear, actionable deliverables • Author and maintain claims processing instructions, policy documentation, and operational guidance in clear, plain language to support both internal teams and client stakeholders • Analyze coding, billing, and claims-related processes and system impacts, ensuring alignment across functional areas and with technical solutions • Serve as a bridge between operations, Business Analysts, and delivery teams, ensuring consistent understanding and application of coding and policy requirements • Participate in and support requirements workshops, design sessions, operational discussions, and client walkthroughs • Ensure adherence to established standards, templates, and documentation practices across all deliverables • Maintain project coordination and communication activities, including capturing and distributing meeting outcomes, tracking status of work items, and providing updates to Project Managers, Business Leads, and stakeholders • Provide guidance to other BAs and functional teams on coding, billing, and policy-related topics, strengthening consistency across the team

• The Precertification Specialist obtains authorizations from Insurance companies for scheduled tests/procedures providing necessary medical information for authorizations. • Interprets patient medical records and reviews cases with the insurance nurse reviewer. • Accurately enters information into multiple computer programs and insurance websites.

Analyze and implement systemic changes for regulatory reporting, conduct root cause analysis, collaborate with partners to resolve issues, and support statistical data delivery for compliance and reporting purposes.

• Leads requirements gathering and analysis for new solutions and system implementations • Collaborates with stakeholders to identify business needs and translate them into functional specifications • Ensures alignment between business objectives and technical solutions • Proactively identifies and mitigates functional risks that could impact solution scalability or user adoption • Establishes pre-implementation baselines to ensure measurable comparison against post-launch outcomes • Develops and implements frameworks to measure solution effectiveness and ROI • Defines KPIs and success metrics for new initiatives • Creates dashboards and reports to track adoption rates, performance improvements, and business outcomes • Conducts post-implementation reviews and recommends optimization strategies • Validates data integrity within dashboards to ensure senior management is making decisions based on single source of truth metrics • Partners with cross-functional teams • Translates complex data into compelling narratives and actionable insights for executive leadership • Presents findings, recommendations, and impact assessments to senior management • Manages expectations and communicates project status effectively • Complies with all the internal rules and regulations of the Company.