Business Analyst III- Medicaid Overpayment Recovery

Title: Business Analyst III – Medicaid Overpayment Recovery Location: Virginia, Florida, Kentucky Hybrid: This role requires associates to be in-office 1-2 days per week, with flexibility for virtual work. The Business Analyst III leads complex data analysis using claims data and coding methodologies (CPT, HCPCS, DRG, ICD-9, ICD-10) to identify overpayment recovery opportunities and validate findings. Responsibilities Primary duties may include, but are not limited to: Collaborate with internal business partners to gather requirements, lead stakeholder discussions, research Medicare and Medicaid reimbursement guidelines, and request or execute data queries to support recovery initiatives and business decisions. Drive continuous process improvements by submitting enhancement requests for recovery projects and reporting tools, coordinating deliverables across stakeholders, and ensuring timely completion of project milestones and business objectives. Analyze complex end user needs to determine optimal means of meeting those needs. Determine business application software requirements to address complex business needs. Develop project plans and identify and coordinate resources, involving those outside the unit. Work with programming staff to ensure requirements will be incorporated into system design and testing. Act as a resource to users of the software to address questions/issues. May provide direction and guidance to team members and serve as an expert for the team. Minimum Requirements BA/BS degree and a minimum of 5 years of business analysis experience; or an equivalent combination of education and experience. Preferred Skills, Capabilities and Experiences Healthcare business analysis experience. Experience using Excel, Facets and MACESS. Medical billing and/or claims processing experience. 5+ years of experience with data analysis, claims processing, provider billing, FWA investigations, cost containment, Medicare, Medicaid, MMP, and/or MedSupp plans. Medical coding experience – CPT, HCPCS, ICD-9/10 coding. CPC or applicable professional designation. Salary range: $73,600 to $110,400 (based on location, experience, skill level) Locations: Virginia Equal Employment Opportunity Statement: Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact View email address on click.appcast.io for assistance. Notice: Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. #J-18808-Ljbffr Elevance Health