Fueled by our bold purpose to improve the health of humanity, we are transforming from a traditional health benefits organization into a lifetime trusted health partner.  

Our nearly 100,000 associates serve more than 118 million people, at every stage of health. We address a full range of needs with an integrated whole health approach, powered by industry-leading capabilities and a digital platform for health. 

We believe that improving health for everyone is possible. It begins by redefining health, reimagining the health system, and strengthening our communities.

Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles from one of our posted Elevance Health locations.

Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending.

The Business Analyst II works within the Cost Containment Unit (CCU) which is an operational unit that leads the effort to identify, analyze, validate and avoid medical overpayments. Cost Containment’s goal is to deliver measurable cost savings through expense recovery and cost avoidance. This will include translating basic business needs into application software requirements.

How You Will Make An Impact

• Analyzes business needs to determine optimal means of meeting those needs.
• Acts as liaison with users of the software to address questions/issues.
• Research all resource documents and web-sites.
• Document findings that support the concept.
• Request and/or run queries as needed to retrieve data.
• Meet with various business partners as needed.
• Submit enhancement request for database updates.
• Ensures proper review of the Forager Pipeline and Analyst reports.
• Commit to deliverables and maintain timely turnaround times.
• Determines specific business application software requirements to address specific business needs.
• Works with programming staff to ensure requirements will be incorporated into system design and testing.
• Perform data mining utilizing CPT, HCPCS, DRG, ICD-9, ICD-10, etc., to identify recovery opportunities.
• Validate overpayments, complete Approach document and forward necessary files and documents for CCU Load

Minimum Requirements

• Requires a BA/BS and minimum of 3 years related business analysis experience, or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities And Experiences

• Healthcare business analysis experience preferred.
• Experience in using Facets, SQL and MACESS highly preferred.
• Medical billing and/or claims processing experience is preferred.
• 2+ years of experience with data analysis, claims processing, provider billing, FWA investigations, cost containment, Medicare, Medicaid, MMP and/or MedSupp plans strongly preferred.
• Medical coding experience - CPT, HCPCS, ICD-9/10 coding preferred.
• CPC or applicable professional designation preferred.
• Proficient of Microsoft Office products, most notably expertise in Excel for reporting, Word, PowerPoint, Teams, and Outlook strongly preferred.

If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a sensitive position work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.