Job Description

Position: Healthcare Business Analyst (Claims and Pre-Authorization)

Location: Parsippany-Troy Hills, NJ, USA(On-Site)

Job Description

Overview:

As a Healthcare Business Analyst specializing in claims processing and pre-authorization, you will play a critical role in optimizing the development of our products. Your expertise will contribute to efficient claims management, accurate pre-authorization decisions, and streamlined processes.

Responsibilities:

• Analyze end-to-end claims workflows, from submission to payment.
• Collaborate with stakeholders (insurers, providers, patients) to identify process improvements.
• Understand how to Ensure compliance with industry standards (e.g., HIPAA)
• Evaluate pre-authorization requests for medical services or procedures.
• Verify medical necessity and adherence to guidelines.
• Facilitate timely approvals by working closely with providers and payers.
• Utilize tools like Excel, SQL, and data visualization platforms.
• Create reports, dashboards, and presentations to communicate insights.
• Monitor performance metrics related to claims and pre-authorization.
• Collaborate with IT teams to enhance products and development of claims processing systems.
• Gather requirements for system upgrades and new features.
• Maintain strong communication with cross-functional business units.

Regards,

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Manoj

Derex Technologies INC

Contact : 973-834-5005 Ext 206

Additional Information

All your information will be kept confidential according to EEO guidelines.