Business Analyst (Claims), Senior

Company Overview Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health.

Think of it as an open invitation to embrace the mission of the company; to actively engage in problem‑solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Job Summary Senior Business Analyst (Claims) to join our growing team. Business Analyst, Specialist is responsible for logical design and functional behavior of solutions involving complex information systems under no supervision for one or more systems including Provider Enrollment, Claims, and Prior Authorization. This role reviews, evaluates, and recommends solutions for various business requirements; provides a fully integrated solution ensuring accomplishment of business requirements; collaborates with customers and stakeholders and uses business modeling techniques to deliver effective “to be” operating models and roadmaps; and works to develop an integrated view of the solution and align the project with the strategic business vision.

Responsibilities Elicit requirements working with customer and stakeholders. Demonstrate in-depth knowledge of business and technical solutioning related to Core Claims to ensure high quality. Work with customers on presenting technical solutions for complex business functionalities.

Possess unwavering commitment to customer service and operational excellence. Provide customer support through leading client demos and presentations. Prioritize and schedule work assignments based on the project plan, handling multiple tasks across project phases.

Create and modify Business Process Models. Understand the overall system architecture and cross‑functional integration. Demonstrate in-depth knowledge of business analysis related to Provider Enrollment, Maintenance and Screening to ensure high quality.

Possess in‑depth knowledge and be well‑versed in multiple functions or capabilities. Use cases, workflow diagrams, and gap analysis to create and modify requirements documents and design specifications. Analyze user requirements and client business needs, leveraging expert opinion and expertise.

Act as the requirements subject matter expert and support requirements change management. Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules. Required Qualifications Bachelor's degree or equivalent experience.

Minimum 5+ years of business analysis experience in the Healthcare Domain with strong knowledge of Medicare/Medicaid Management Information System around Core Claims and/or Provider Management and Enrollment System experience. Minimum 5 years of experience on large complex projects and domain knowledge of Medicare healthcare vertical. Strong knowledge in Medicare policies and guidelines.

Strong knowledge in claims adjudication and validation. Strong knowledge in Medicare reimbursement methodologies. Excellent Business Analysis Process (SDLC, documentation procedures) experience.

Excellent customer relation skills including presentation and meeting facilitation. Experience facilitating and running customer‑facing requirements and design sessions. Excellent requirements elicitation and validation skill.

Strong knowledge and proficiency in SQL, plus high‑level technical and database knowledge. Preferred Qualifications No additional preferred qualifications provided. Benefits Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Compensation USD $95,360.00 - USD $119,200.00 per year. EEO Statement Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law. #J-18808-Ljbffr