Business Systems Analyst

Job Title

Top 3 Must Have Skillsets

Direct experience in Availity transactions including Eligibility & Benefits (270/271), Claims Status (276/277), Prior Authorization (278), Attachments, and Claims (837/835). Healthcare payer business system analyst. SQL

Responsibilities

Conducts end-to-end analysis of payer and provider workflows involving Availity transactions including Eligibility & Benefits (270/271), Claims Status (276/277), Prior Authorization (278), Attachments, and Claims (837/835). Evaluates business requirements, integration patterns, and data flows to ensure alignment with Availity capabilities and enterprise-level operational expectations. Reviews Availity response data, error codes, payer-specific rules, and transaction-level exceptions to validate accuracy, completeness, and adherence to EDI standards. Supports implementation, enhancement, and optimization of Availity portal features, API integrations, and clearinghouse configurations. Leads requirement-gathering sessions with operations, product teams, and technical stakeholders; documents functional requirements, user stories, acceptance criteria, and workflow diagrams. Assesses business impact of Availity-related changes, EDI mapping updates, and upstream/downstream process modifications. Performs root cause analysis for transaction failures, rejections, eligibility discrepancies, and authorization processing issues. Develops test plans, executes UAT, and validates end-to-end transaction integrity for enhancements related to Availity workflows. Prepares documentation, reporting summaries, analysis logs, and communication materials for both technical and non-technical teams. Conducts research and evaluation of clearinghouse rules, EDI compliance requirements, and payer implementation guides. May provide SME guidance to project teams and serve as a resource for Availity operations, payer-provider transactions, and healthcare EDI standards.

Requirements

Bachelor's degree in Healthcare Administration, Information Systems, Business, or a related field; minimum of 5 years of experience as a Healthcare Business Analyst within a payer or provider environment. Hands-on experience with Availity Portal, Availity APIs, or clearinghouse integrations is required. Strong understanding of HIPAA-standard EDI transactions (270/271, 276/277, 278, 837, 835) and healthcare administrative operations. Experience documenting business requirements, process flows, and business rules across eligibility, claims processing, and authorization domains. Familiarity with healthcare data protection expectations and payer/provider transaction guidelines. Experience supporting business operations, compliance reviews, or audit-related activities in a healthcare context. Ability to analyze transaction data, troubleshoot integration issues, and interpret Availity error responses and payer communication. Strong written and verbal communication skills, including the ability to develop clear documentation and communicate findings effectively. Comfortable working with cross-functional U.S.-based teams and managing business discussions directly with stakeholders. Proficiency with productivity and analysis tools such as MS Word, MS Excel, JIRA, Confluence, and standard EDI/Availity reporting formats.