Job Description

We are seeking a Healthcare Business Analyst to support eligibility, benefits, claims, and provider data exchange initiatives.

The ideal candidate will have strong analytical skills, hands?on experience with Availity portal and clearinghouse integrations, and the ability to collaborate effectively with business, operations, and technical stakeholders across distributed teams.

Key Responsibilities

• Conduct end?to?end analysis of payer and provider workflows involving Availity transactions, including Eligibility & Benefits (270/271), Claims Status (276/277), Prior Authorization (278), Attachments, and Claims (837/835).
• Evaluate business requirements, integration patterns, and data flows to ensure alignment with Availity capabilities and enterprise?level operational expectations.
• Review Availity response data, error codes, payer?specific rules, and transaction?level exceptions for accuracy and compliance with EDI standards.
• Support implementation, enhancement, and optimization of Availity portal features, API integrations, and clearinghouse configurations.
• Lead requirement?gathering sessions with operations, product teams, and technical stakeholders; document functional requirements, user stories, acceptance criteria, and workflow diagrams.
• Assess business impact of Availity?related changes, EDI mapping updates, and upstream/downstream process modifications.
• Perform root cause analysis for transaction failures, rejections, eligibility discrepancies, and authorization processing issues.
• Develop test plans, execute UAT, and validate end?to?end transaction integrity for enhancements related to Availity workflows.
• Prepare documentation, reporting summaries, analysis logs, and communication materials for technical and non?technical teams.
• Conduct research and evaluation of clearinghouse rules, EDI compliance requirements, and payer implementation guides.
• Provide SME guidance to project teams and serve as a resource for Availity operations, payer?provider transactions, and healthcare EDI standards.

Required Qualifications

• Bachelors degree in Healthcare Administration, Information Systems, Business, or related field.
• Minimum of 5 years of experience as a Healthcare Business Analyst within a payer or provider environment.
• Hands?on experience with Availity Portal, Availity APIs, or clearinghouse integrations.
• Strong understanding of HIPAA?standard EDI transactions (270/271, 276/277, 278, 837, 835).
• Experience documenting business requirements, process flows, and business rules across eligibility, claims processing, and authorization domains.
• Familiarity with healthcare data protection expectations and payer/provider transaction guidelines.
• Ability to analyze transaction data, troubleshoot integration issues, and interpret Availity error responses.
• Strong written and verbal communication skills.
• Comfortable working with cross?functional U.S.-based teams and managing business discussions directly with stakeholders.
• Proficiency with productivity and analysis tools such as MS Word, MS Excel, JIRA, Confluence, and standard EDI/Availity reporting formats.

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