Business Analyst

Job Description:

Works collaboratively with the client and team members-both external and internal to the company - to research, validate and document business needs, and to ensure that those needs are clearly reflected and completed. Assists with translating business needs into system/ application and may help determine solutions to business problems. Lead the unit in meetings and act as a subject matter expert within the unit. Effectively manages client's expectations.

Responsibilities:
o Ensure that items are prepared for client meetings.
o Work with the client on claims related items, using strong communication skills to elicit, document, analyze and validate business processes and client expectations.
o Research, identify, and specify solutions to problems.
o Document claim updates as well as reference updates/changes.
o Work with the BPA team on reference changes and system updates.
o Review and work claims that have been identified as a high priority by the client.
o Assist with quarterly and annual CPT, HCPCS and diagnosis code updates in the system, ensuring rules are correct and working on edit and audit configuration.
Education and Experience Required:
o 5+ years of healthcare claims experience
o Certified coder is a plus
o Must know CPT, HCPCS and ICD-10 coding
o Must be proficient in Excel
Knowledge and Skills:
o 5+ years of healthcare claims experience
o Must work collaboratively in a team environment in making changes to the claims system for CPT, HCPCS and ICD-10 coding updates and benefit plan coverage.
o Build relationships and working collaboratively; effective verbal/ written communication.
o Ability to assist/create manual documentation as well as provider notifications

PME is an equal opportunity employer. We prohibit discrimination and harassment against any applicant or employee based on any legally recognized basis, including, but not limited to: veteran status, uniformed servicemember status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy, national origin or ancestry, citizenship status, physical or mental disability, genetic information (including testing and characteristics) or any other category protected by federal, state or local law.