Job Description

Job Title: Business Systems Analyst


Location: Remote (PST)


Job Type: Contract

Job Description:

• Primary duties may include, but are not limited to:
• Conducts 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).
• Evaluates business requirements, integration patterns, and data flows to ensure alignment with Availity capabilities and enterprise-level operational expectations.
• Reviews Availity response data, error codes, payer-specific rules, and transaction-level exceptions to validate accuracy, completeness, and adherence to EDI standards.
• Supports implementation, enhancement, and optimization of Availity portal features, API integrations, and clearinghouse configurations.
• Leads requirement-gathering sessions with operations, product teams, and technical stakeholders; documents functional requirements, user stories, acceptance criteria, and workflow diagrams.
• Assesses business impact of Availity-related changes, EDI mapping updates, and upstream/downstream process modifications.
• Performs root cause analysis for transaction failures, rejections, eligibility discrepancies, and authorization processing issues.
• Develops test plans, executes UAT, and validates end-to-end transaction integrity for enhancements related to Availity workflows.
• Prepares documentation, reporting summaries, analysis logs, and communication materials for both technical and non-technical teams.
• Conducts research and evaluation of clearinghouse rules, EDI compliance requirements, and payer implementation guides.
• May provide SME guidance to project teams and serve as a resource for Availity operations, payer-provider transactions, and healthcare EDI standards.
  
  

Skills:

• Direct Experience in Availability transactions including Eligibility & Benefits (270/271), Claims Status (276/277), Prior Authorization (278), Attachments, and Claims (837/835).
• Healthcare payer business system analyst
• SQL
  
  
  
  

Job Tags

Similar Jobs