Senior Business Analyst - Pharmacy (RCM, Billing & Financial Reconciliation)

Overview 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 Education Bachelor’s Degree in Healthcare, IT, Business, or related field (or equivalent experience) 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) Working Conditions 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% Compensation and Benefits Inovalon offers a competitive salary and benefits package. The base compensation range is $109,000—$143,600 USD. This position may be eligible for performance-based incentives. Compensation decisions are based on job-related knowledge, skills, experience, business needs, location, and internal equity. Benefits may include health insurance, life insurance, company‑paid disability, 401k, 18+ days of paid time off, and more. Employment Eligibility This position is not eligible for immigration sponsorship. Applicants must be authorized to work in the United States. Equal Opportunity Employment Inovalon is proud to be an equal opportunity workplace. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, veteran status, or criminal history, consistent with legal requirements. #J-18808-Ljbffr