TC
Business Systems Analyst
TechDigital Corporation
- 🇺🇸 United States
- 9 months ago
- prior authorization
- SQL
- EDI
- HIPAA
- Excel
- Jira
- Confluence
9 months ago
o Direct Experience in Availity transactions including Eligibility & Benefits (270/271), Claims Status (276/277), Prior Authorization (278), Attachments, and Claims (837/835).
o Healthcare payer business system analyst
o SQL
Responsibilities
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.
Requirements
• Bachelor's degree in Healthcare Administration, Information Systems, Business, or a 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 is required.
• Strong understanding of HIPAA-standard EDI transactions (270/271, 276/277, 278, 837, 835) and healthcare administrative operations.
• 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.
• Experience supporting business operations, compliance reviews, or audit-related activities in a healthcare context.
• Ability to analyze transaction data, troubleshoot integration issues, and interpret Availity error responses and payer communication.
• Strong written and verbal communication skills, including the ability to develop clear documentation and communicate findings effectively.
• 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.
Business Systems Analyst · TechDigital Corporation