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

Contract work,

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