Lead Business Analyst, Implementation

$100,000 - $125,000/Yr

Evolent Health - Richmond, VA

Full-time - Mid Level

Richmond, VA

Professional, Scientific, and Technical Services

About the position

The position involves spearheading requirements management for implementation projects at Evolent, focusing on delivering value-based strategies in collaboration with various stakeholders. The role is pivotal in driving the company's mission and contributing to initiatives that enhance departmental growth and team performance.

Responsibilities

• Clearly define requirements, process flows, use cases, and acceptance criteria for CMS and Commercial programs.
• Facilitate communication between business/IT teams, developers, and external stakeholders.
• Identify, document, and analyze discrepancies and anomalies within automated data reconciliation and disputed data.
• Document business and system requirements standards when new system enhancements or engineering changes are required.
• Maintain standard templates and support ongoing maintenance.
• Develop a deep understanding of end user outputs, platform development & configuration, multisystem functional requirements, and business rules.
• Leverage knowledge to improve processes, recommend solutions, enhance team performance, and drive progression of client objectives.
• Prioritize mitigation efforts for action items, risks, and issues.
• Analyze and address process and software gaps.

Requirements

• Bachelor's degree or equivalent experience.
• 5-8+ years of IT and/or business experience in an HMO/PPO Claims, Medicaid, Medicare, and/or managed care healthcare environment.
• Able to own and write the Business Requirement Document (BRD) independently for any given domain function with minimal assistance.
• Knowledge of the Affordable Care Act, HMO and managed care principles including Medicaid and Medicare regulation.
• Extensive experience with the System Design Life Cycle (SDLC).
• Experience with EDI X12 structure and syntax rules, chiefly with 834 files.
• Superior root cause analysis skills, including corrective action planning and ability to provide documentation to support analysis.

Benefits

• Comprehensive health insurance benefits
• Bonus component based on pre-defined performance factors