Expert Claims Review Business Analyst

Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. The Business Analyst is responsible for enabling high quality business analytics solutions in an Agile or Kanban context, facilitating communication between stakeholders and enhancing Zelis’ capacity to meet IT needs in healthcare.

Responsibilities:

• Participate in relevant ceremonies: Daily Stand-Ups, Backlog Grooming, Sprint Planning, Sprint Review, Sprint Retrospective
• Leverage AI through all aspects of the role to facilitate user stories and requirements, acceptance criteria or any other aspect of their role
• Assist with the elaboration of the user stories and requirements, supporting team members with their work where required
• Be responsible for providing multi-disciplinary teams with user stories and coaching to define the business-driven acceptance criteria and test cases. Proactively support the uplift of Agile or Kanban practices and foster a culture of continual service improvement
• Consult with the business and product owners to prioritize and shape the product backlog, using Agile or Kanban practices for prioritization around business value
• Define, implement, and maintain business processes and procedures to meet business objectives. Analyze and identify opportunities for business process improvements
• Collaborate with Solution Owners and/or Product Managers when defining product release content and timeline, applying product development principles, innovative thinking and a focus around the customer or user experience
• Critically evaluate information gathered from multiple sources, reconcile conflicts, and decompose high-level information into details
• Create and maintain workflows, approval processes, and validation rules based on internal stakeholder requirements
• Create training materials and documentation for internal and/or external applications
• Perform a thorough gap analysis of existing to potential functionality for internal and/or external applications
• Create Release Notes as determined by Product Owner
• Perform analysis and identify gaps in functionality for system integrations
• Collaborate with the Scrum team to establish the technical vision and analyze tradeoffs between usability and performance needs
• Improves systems by studying current practices, designing modifications
• Assist in Quality Assurance (QA) and/or User Acceptance Testing (UAT) of new software or enhancements to existing software as needed
• The ability to multi-task and work on multiple assignments will be required

Requirements:

• Bachelor's Degree
• 4+ years of experience with Business Analysis and/or Business Process Engineering
• Disciplined, structured and logical approach to problem solving
• Ability to learn a new business and translate these needs into new products, and perform high-level troubleshooting functionality
• Solid troubleshooting, analytical, and business process development skills
• Clear and concise communication both verbally and in writing
• Experience in Healthcare industry preferred
• Knowledge of Payment Integrity solutions (hospital billing, claims editing, reimbursement methodologies and acceptable billing practices) preferred
• Knowledge of payer reimbursement policies, state and federal regulations and applicable industry standards preferred
• SQL experience preferred
• Preferred - SAFe POPM, Agilist, Teams, or Leading Safe certification