Business Analyst - Operations

About this role

Pinnacle Method Consulting's mission is to help job seekers reach their career peak by accessing top-tier opportunities. We are not a staffing firm or agency. Pinnacle Method does not hire for these roles—we systematically source and verify them from premier employers.


Employer Industry: Healthcare Payment Integrity


Why Consider This Job Opportunity

• Opportunity for career advancement and growth within the organization
• Supportive and collaborative work environment
• Chance to make a positive impact on financial accuracy and payment integrity in healthcare
• Work with cross-functional teams, including IT, QA, and operations
• Engage with evolving healthcare regulations and payer policies

What To Expect (Job Responsibilities)

• Elicit, analyze, and document business requirements (BRDs, FRDs, acceptance criteria, process flows)
• Partner with stakeholders to translate business needs into system requirements for PI products
• Conduct claims data analysis to identify trends, validate audit findings, and support product design
• Collaborate with IT, QA, and operations teams to ensure requirements are implemented and tested accurately
• Track and report performance metrics, savings impact, and accuracy rates for PI solutions

What Is Required (Qualifications)

• Bachelor's degree in Business, Healthcare Administration, Data Analytics, or related field (or equivalent experience)
• Minimum of 3 years as a Business Analyst in healthcare, payer, or PI environment
• Strong understanding of claims processing (professional, facility, pharmacy) and related transactions (837, 835, COB, EOBs)
• Experience documenting detailed requirements and acceptance criteria
• Proficiency in SQL/Excel; familiarity with BI tools is a plus

How To Stand Out (Preferred Qualifications)

• Prior work with DRG auditing, HBA, COB, IBR, or edit engine configuration
• Knowledge of medical coding standards (ICD, CPT, HCPCS)
• Familiarity with payer SIU/FWA operations or s...