Sr. Healthcare Business Analyst

About this role

Job Title: Senior Healthcare Business Analyst

Department: Claims Operations

Reports To: CEO

Budget Responsibility: None

Level of Authority: Staff Position

Job Summary

This position is responsible for supporting accurate and efficient claims processing by assisting with claims system configuration, auto-adjudication, electronic data (EDI) files, analysis and reporting. The role also provides analytical and operational support across business functions, including claims, encounters, eligibility, capitation, and data reporting.

Who We Are

Independent Clinics of Washington (ICW) is an alliance of local healthcare providers dedicated to offering Medicaid and Medicare patients high-quality, individualized care while helping independent practices stay independent. ICW helps local providers build their practices and care for their patients by managing administrative tasks, negotiating rates with plans, cutting red tape for faster claims processing, minimizing authorization requirements, advocating for patients, connecting local providers in a supportive network, and more.

We strive to build an inclusive, supportive work culture and are looking for a new teammate who excels as a collaborator and will contribute to the positive environment.

Key Responsibilities

• Review the claims system configuration to increase accurate auto-adjudication rates by analyzing pended, manually processed, and auto-released claims and identifying configuration fixes
• Create and maintain data dictionaries documenting fields, definitions, and sources
• Develop, maintain, and document internal and external reporting in SSRS and Excel
• Develop and maintain the 835 remittance process, including file generation, data mapping, validation, and reconciliation
• Support configuration and maintenance of 837 EDI mapping
• Maintain fee schedule and benefit matrix configuration, using SQL and Excel to prepare data loads, validate rates and benefit rules against source files, and id...