Business Analyst, Consultant

Your Role The Clinical Coding team seeks an experienced Business Analyst, Consultant with strong analytical, business, and technical expertise to support complex, cross functional initiatives. This role is responsible for analyzing data, defining business requirements, and driving operational improvements related to payment policy, medical policy, and coding related processes, while also contributing to the development of annual operating plans, budgets, forecasts, and cost/benefit analyses for new initiatives. The Business Analyst, Consultant will report to the Sr. Manager, Clinical Coding. In this role, you will play a critical role in ensuring payment and medical policy logic is accurately translated into system configuration, directly impacting claims accuracy, regulatory compliance, and cost of healthcare outcomes, while influencing cross-functional decision-making through expert analysis and identification of improvement opportunities. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning. Your Knowledge and Experience Requires a bachelor's degree or equivalent experience Requires at least 7 years of prior relevant experience Requires deep knowledge of job area typically obtained through advanced education combined with experience. Requires strong knowledge of business analysis, payment policy, California state mandates and claims operations Requires at least 3 years of Payment policies and claims processing or equivalent experience Familiarity with provider manuals, CMS/NCCI guidelines, and payment integrity operations Requires knowledge of ClaimsXten or similar claims editing software Strong analytical and problem-solving skills with ability to conduct independent research and synthesize findings Advanced knowledge and ability to perform process mapping, root-cause analysis, gap analysis and requirements gathering Requires practical knowledge of project management Ability to deal with complexity, compressed timelines and shifting priorities Proficient with MS Office products, including Word, PowerPoint and Excel. Visio expertise a plus Strong interpersonal and verbal and written communication skills. Agile experience preferred Hybrid This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week. Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need. #J-18808-Ljbffr Blue Shield of CA