Business Analyst Healthcare A&G
Pinnacle Method Consulting
Job Overview
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Job Description
Job Summary: Business Analyst Healthcare A&G
Pinnacle Method Consulting is seeking a skilled Business Analyst Healthcare A&G to source for a premier employer in the Managed Care and Health Insurance industry. This role offers a competitive salary, robust benefits, and significant opportunities for career growth within a flexible, remote work environment. You will play a crucial role in regulatory compliance and governance, contributing to a mission-driven organization focused on healthcare improvement.
Key Responsibilities
- Develop and maintain requirement documents related to coverage, reimbursement, and system changes.
- Monitor sources to ensure updates align with regulatory requirements.
- Lead the development and management of review processes with key partner organizations.
- Conduct analysis to identify root causes and assist in problem management related to state requirements.
- Communicate requirement interpretations and changes to health plans and various corporate functional areas.
Qualifications
To succeed in this role, you should possess:
- At least 2 years of experience in a managed care organization, health insurance, or a related field.
- Knowledge of policy and government legislative review.
- Strong analytical and problem-solving skills.
- Proficiency in Office Product Suite, including Word, Excel, Outlook, and Teams.
- Previous success in a dynamic and autonomous work environment.
Preferred Qualifications
Candidates who stand out will also have:
- Project implementation experience.
- Knowledge of federal regulatory policies, including CMS and the Affordable Care Act (ACA).
- Medical Coding certification.
- Experience with Jira.
- Familiarity with Appeals & Grievances processes.
Why This Opportunity Matters
This is a chance to engage with diverse teams, contribute to vital compliance efforts, and support healthcare improvement from a remote setting. The employer offers a supportive environment focused on professional development and work-life balance.
Key Skills/Competency
- Managed Care
- Health Insurance
- Regulatory Compliance
- Business Analysis
- Requirement Documentation
- Problem Solving
- Healthcare Policy
- Government Legislation
- Appeals & Grievances
- Jira
How to Get Hired at Pinnacle Method Consulting
- Understand Pinnacle Method Consulting's role: Recognize they source roles, and your application is for a premier employer they've identified, not PMC directly.
- Tailor your resume for healthcare analytics: Highlight 2+ years in managed care or health insurance, emphasizing regulatory compliance and analytical achievements.
- Showcase policy and legislative knowledge: Emphasize experience with government legislative review, CMS, and ACA on your resume and in interviews.
- Prepare for a remote, autonomous environment: Demonstrate self-motivation, strong communication, and problem-solving skills for independent work.
- Connect your skills to healthcare impact: Articulate how your analytical and compliance expertise contributes to healthcare improvement and organizational goals.
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