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AmeriHealth Caritas · 3 hours ago

Payment Integrity Business Analyst Senior

United States

Full-time

Remote

Mid, Senior Level

3+ years exp

AmeriHealth Caritas is a mission-driven organization focused on delivering comprehensive healthcare solutions. The Payment Integrity Business Analyst Senior is responsible for supporting initiatives that drive accuracy and operational integrity through data analysis and business process improvement, collaborating with cross-functional teams to support project implementations and ensure compliance with regulatory standards.

Health CareInformation Technology

H1B Sponsor Likely

Responsibilities

Documents and maintains detailed business requirements and payment integrity workflows

Collaborates with team members and stakeholders to identify business needs and business requirements

Conducts root cause analysis and makes recommendations for improvements. Presents analysis, ideas, and positions in writing in a clear and convincing manner

Support the development and management of provider communications, training materials, and policy updates

Supports the design, development and implementation of new /changed business processes and procedures utilizing proven process improvement methodologies

Monitors regulatory and policy changes to ensure payment integrity strategies remain compliant

Assists in pre-RFP and RFP work. Represents Payment Integrity at Corporate RFP meetings. Serves as a technical resource for functional areas in responding to RFPs (identifying standard or historical responses) and coordinates responses with other departments, as necessary. Works collaboratively with functional areas to ensure proposed RFP responses align with current enterprise standards and guidelines and provides feedback when appropriate. Reviews the final version of draft responses submitted for accuracy and usability prior to submission to Management for review

Collaborates with cross-functional teams to support project execution

Monitors project activities to ensure the quality and timeliness of processes as well as ensuring adherence to all company goals and initiatives

Supports new business initiatives/expansions to ensure operational readiness. Prepare for and facilitating team meetings to review, refine and finalize deliverables as applicable

Develops and maintains reports to track activities including readiness reviews, audits, and RFPs

Supports SharePoint Site maintenance to support future initiatives and provides data upon request in a useable format. Updates site to include new business standard documents, workflows, and processes

Qualification

Data analysisBusiness process improvementHealthcare payment integrityMicrosoft Office SuiteRFP processesAttention to detailCollaboration skillsVerbal communicationWritten communication

Required

Bachelor's Degree

At least two (2)+ years of experience in healthcare payment integrity or healthcare operations

At least three (3)+ years of experience in a Business Analyst role

Strong analytical skills, adept in data analysis and data presentation

Proficient working knowledge of Microsoft Office Suite, including Excel, SharePoint Online, PowerPoint, Teams, Word, and Tableau

Ability to work independently and collaboratively to manage multiple projects and tasks to completion

Knowledge of provider reimbursement methodologies, healthcare regulations and audit practices

Ability to present information in a clear and concise manner, both written and verbal

Preferred

Previous experience working in healthcare preferred

Experience with RFP processes and implementation project support is highly desirable

Attention to detail with the ability to source data and synthesize solutions to connect people, processes, and technology

Benefits

Flexible work solutions including remote options

Hybrid work schedules

Competitive pay

Paid time off including holidays and volunteer events

Health insurance coverage for you and your dependents on Day 1

401(k)

Tuition reimbursement

Company

AmeriHealth Caritas

Glassdoor3.4

AmeriHealth Caritas is the health care solutions provider for those in most need and the chronically ill.

Founded in 1982

Philadelphia, Pennsylvania, USA

10001+ employees

http://www.amerihealthcaritas.com

H1B Sponsorship

AmeriHealth Caritas has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (18)

2024 (17)

2023 (12)

2022 (14)

2021 (4)

2020 (11)