Senior Business Analyst

divh2Senior Business Analyst/h2pWe are seeking a Senior Business Analyst to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations./ppThe Senior Business Analyst in Health Care Services plays a pivotal role in bridging the gap between clinical operations and technology solutions to enhance member care and organizational efficiency. This position is responsible for analyzing complex business processes, identifying areas for improvement, and designing effective strategies that align with healthcare regulations and standards. The role requires collaboration with cross-functional teams including clinical staff, IT professionals, and management to gather requirements and translate them into actionable project plans. The Senior Business Analyst will lead initiatives that drive data-driven decision-making and support the implementation of innovative healthcare solutions. Ultimately, this role ensures that business objectives are met while maintaining compliance and improving overall service delivery within the healthcare environment./ppMinimum Qualifications:/pulliAssociates degree in Business Administration, Health Informatics, or a related field./liliAt least 4 years of experience as a Business Analyst within the healthcare industry./liliProficient knowledge of UB04 / CMS-1500 claim adjudication process, including Medicare and Medicaid reimbursement methodologies (i.e. Per Diem, PPS, FFS, APG, Capitation, etc.) required./liliMust possess good understanding of claim adjudication process including ICD, CPT, HCPCS/liliStrong proficiency in business analysis tools and methodologies, including requirements gathering and process mapping./liliRelevant experience may substitute for the educational requirement on a year-for-year basis./li/ulpPreferred Qualifications:/pulliBachelors degree in Health Administration, Public Health, or a related discipline./liliCertification such as Certified Business Analysis Professional (CBAP) or Certified Healthcare Business Analyst (CHBA)./liliExperience with Electronic Health Record (EHR) systems and healthcare data analytics platforms./liliKnowledge of healthcare quality improvement frameworks and member safety standards./liliExperience working in agile project environments./li/ulpResponsibilities:/pulliMaintain data integrity of provider set-ups and reimbursement configurations, including timely updates and troubleshooting./liliLoad and implement practitioner, hospital, and ancillary contracts into the claims system, including amendments and claims testing./liliProgram and maintain pricing setups based on contract specifications across various care settings (e.g., inpatient, outpatient, ER)./liliParticipate in client implementations, conversions, and internal/external meetings to support operational needs./liliCreate documentation for workflows and policies and mentor staff on complex contract configurations./li/ul/div