Senior Business Analyst – Pharmacy (RCM, Billing & Financial Reconciliation)

Location: This position is designated as remote. However, employees who reside within a 40-mile radius of one of our office locations in Tampa, FL; Canonsburg, PA; or Bowie, MD will follow a hybrid work schedule and are expected to work in the office two days per week (Tuesdays and Wednesdays).

Overview

We are seeking a highly experienced Senior Business Analyst with deep expertise in specialty/infusion pharmacy, medical billing, and financial reconciliation to support enterprise SaaS implementations. This role serves as a critical liaison between clients, operations, product, and engineering teams to define business requirements, design future-state workflows, and ensure successful delivery of Revenue Cycle Management (RCM) solutions.

The ideal candidate brings strong domain knowledge in pharmacy billing, claims adjudication, payment posting, and reconciliation, and plays a key role across the full client lifecycle—from pre-sales through implementation and post-go-live optimization.

Key Responsibilities

Delivery & Strategic Execution

• Lead complex and enterprise-wide implementations with multiple integrated workstreams

• Own RCM functional track deliverables, ensuring alignment across stakeholders

• Define governance standards, implementation plans, and risk mitigation strategies

• Drive future-state workflow design across pharmacy operations and revenue cycle processes

• Manage release coordination, dependencies, and cross-functional execution

Pharmacy Billing & Revenue Cycle Expertise

• Serve as Subject Matter Expert (SME) in:

  • Medical and pharmacy billing (specialty and infusion)

  • Claims lifecycle management (submission, adjudication, reversals, rebilling)

  • Payment posting, ERA (835), and financial reconciliation

• Optimize workflows to improve:

  • Clean claim rate and first-pass yield

  • Denial management and resolution

  • Days in Accounts Receivable (A/R)

  • Net collections and revenue leakage prevention

• Analyze and resolve billing discrepancies including underpayments, overpayments, and unapplied cash

• Ensure alignment between pharmacy systems, billing platforms, clearinghouses, and financial systems

Client Engagement & Product Collaboration

• Work closely with clients to gather and define RCM and operational requirements

• Translate client needs into business and system requirements for product development

• Provide business case justification for product enhancements

• Participate across the full lifecycle:

  • Request for Proposal (RFP )esponses and product demos

  • Implementation, testing, and go-live

  • Post-production support and optimization

• Partner with Product Managers on roadmap and knowledge sharing

Requirements & Process Analysis

• Elicit, document, and manage business and system requirements (BRDs, design documents)

• Develop process workflows using tools such as Visio

• Analyze current systems and identify improvement opportunities

• Assess impacts of proposed solutions across systems, workflows, and stakeholders

Technical & Data Capability

• Work within SaaS environments utilizing Agile/Scrum and full SDLC practices

• Support system configuration and ensure alignment with business requirements

• Define data requirements and support reporting and reconciliation processes

• Utilize tools such as SQL and Crystal Reports for data validation and analysis

• Support integrations across APIs, FHIR/HL7, claims (NCPDP/837), and remittance (835)

Validation & Quality Assurance

• Lead User Acceptance Testing (UAT) strategy, planning, and execution

• Participate in system validation prior to release

• Triage and resolve escalated defects in collaboration with QA and engineering

• Ensure delivered solutions meet client, operational, and financial expectations

Stakeholder & Leadership Responsibilities

• Act as a trusted advisor to clients and internal leadership

• Lead cross-functional discussions and align business and technical teams

• Support training initiatives and knowledge transfer

• Mentor junior analysts and promote BA best practices

Operational Excellence & Business Impact

• Drive improvements in onboarding, billing accuracy, and operational efficiency

• Support standardization, scalability, and adoption of solutions

Compliance & Governance

• Ensure adherence to HIPAA, DEA, State Board, and regulatory requirements

• Maintain compliance with Inovalon policies and procedures

• Support audit readiness and financial accuracy

Qualifications

Education

• Bachelor’s Degree in Healthcare, IT, Business, or related field (or equivalent experience)

Experience

• 5+ years of Business Analysis experience in healthcare or SaaS

• 2+ years of experience in medical billing and financial reconciliation

• Experience in specialty or infusion pharmacy environments preferred

• Strong background in Revenue Cycle Management (RCM)

Working Conditions

• Primarily sedentary role involving extended periods of sitting and computer use

• Occasional lifting (up to 10 pounds)

• Ability to work in a fast-paced, dynamic environment

• Travel for this position will include up to 10%

This position is not eligible for immigration sponsorship (e.g. H-1B, TN, or E-3). Applicants must be authorized to work in the United States as a condition of employment. (This is only applicable for US-based positions)

If you don’t meet every qualification listed but are excited about our mission and the work described, we encourage you to apply. Inovalon is most interested in finding the best candidate for the job, and you may be just the right person for this or other roles.

By embracing inclusion, we enhance our work environment and drive business success. Inovalon strives to provide equal opportunities to the communities where we operate and to our clients and everyone whom we serve. We endeavor to create a culture of inclusion in which our associates feel empowered to bring their full, authentic selves to work and pursue their professional goals in an equitable setting. We understand that by fostering this type of culture, and welcoming different perspectives, we generate innovation and growth.

Inovalon is proud to be an equal opportunity workplace. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or veteran status. We also consider qualified applicants regardless of criminal histories, consistent with legal requirement.

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