Lead Business Analyst, Implementation

$100,000 - $125,000/Yr

Evolent Health - Albany, NY

Full-time - Mid Level

Albany, NY

Professional, Scientific, and Technical Services

About the position

The Lead Business Analyst, Implementation at Evolent Health is responsible for spearheading requirements management for implementation projects, collaborating with various stakeholders to drive the company's mission of improving health outcomes. This role involves defining requirements, facilitating communication between teams, and analyzing discrepancies in data to enhance processes and support client objectives.

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.
• 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 performance factors