Overview
Remote
57
Full Time
No Travel Required
Unable to Provide Sponsorship
Skills
Availity Portal
API
clearinghouse integrations
EDI
CLAIMS
Job Details
Business Systems Analyst
Location: Remote
Duration: 12 Months
Job Type: Temporary Assignment
Work Type: Remote - PST
Job Description:
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 EDI standards.
Requirements
- Bachelor’s degree in the Administration, Information Systems, Business, or a related field; minimum of 5 years of experience as a 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 the administrative operations.
- Experience documenting business requirements, process flows, and business rules across eligibility, claims processing, and authorization domains.
- Familiarity with the data protection expectations and payer/provider transaction guidelines.
- Experience supporting business operations, compliance reviews, or audit-related activities in a 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.
Top 3 must have skillsets
- Direct Experience in Availity transactions including Eligibility & Benefits (270/271), Claims Status (276/277), Prior Authorization (278), Attachments, and Claims (837/835).
- The client payer business system analyst
- SQL
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