Lead Claims Business Analyst

A client of Innova Solutions is immediately hiring for a Lead Claims Business Analyst. Position type: Full-time Contract Duration: 4 Months Location: Philadelphia, PA As a Lead Claims Business Analyst, You Will • Develop policy enforcement requirements based on medical and claim payment policy criteria. Types of enforcement include but are not limited to claim system, prior authorization, desk level procedures, and post-payment review. • Collaborate with internal business colleagues within the department to gain an understanding of policy criteria, and medical coding rules, to assess systems capabilities. • Collaborate with other departments and external vendors to ensure the accurate implementation of policies according to business requirements. • Identify policies that require manual review of policy criteria when systematic enforcement is not an option or not recommended. • Provide timely documented feedback on issues identified at the system level and execute escalation procedures, including corrective action plans, as applicable. • Provide quality assurance through development and review of claims data utilization reports to ensure assigned policies are enforced according to business requirements. • Provide review and resolution of claims incidents resulting from policy set-up issues. Follow-through until all impacted claims are identified and adjusted and provide proper reporting. • Perform root cause analysis to determine source of policy set-up issues. Perform User Acceptance Testing in collaboration with external vendor. • Provides input to regulatory and other oversight teams regarding adherence to compliance requirements. The Ideal Candidate Will Have • Bachelor's degree in relevant discipline or equivalent work experience. • Minimum of five years related Claims, Operations or Business Requirement Development experience. • Proven competency with various business tools, such as Microsoft Excel, Word, PowerPoint, SharePoint, and Teams. Preferred Skills & Qualifications • Current coding certification i.e., CCS, CPC, RHIA, RHIT. • Working knowledge of Healthrules Payer or Source claims processing system. • Experience in Medical coding. • Familiarity with CMS processing rules. Qualified candidates should APPLY NOW for immediate consideration! This position is only open to applicants who can be engaged on a W-2 basis. Please hit APPLY to provide the required information, and we will be back in touch as soon as possible. We are currently interviewing to fill this and other similar positions. If this role is not a fit for you, we do offer a referral bonus program for referrals that we successfully place with our clients, subject to program guidelines. ASK ME HOW. Thank you! Gangotri Chakraborty (+1) 4708452815 Gangotri.chakraborty@innovasolutions.com Pay Range And Benefits Pay Range • :$52.00 - $55.00 per hour • Pay range offered to a successful candidate will be based on several factors, including the candidate's education, work experience, work location, specific job duties, certifications, etc. Benefits: Innova Solutions offers benefits( based on eligibility) that include the following: Medical & pharmacy coverage, Dental/vision insurance, 401(k), Health saving account (HSA) and Flexible spending account (FSA), Life Insurance, Pet Insurance, Short term and Long term Disability, Accident & Critical illness coverage, Pre-paid legal & ID theft protection, Sick time, and other types of paid leaves (as required by law), Employee Assistance Program (EAP). ABOUT INNOVA SOLUTIONS:Founded in 1998 and headquartered in Atlanta, Georgia, Innova Solutions employs approximately 50,000 professionals worldwide and reports an annual revenue approaching $3 Billion. Through our global delivery centers across North America, Asia, and Europe, we deliver strategic technology and business transformation solutions to our clients, enabling them to operate as leaders within their fields. Recent Recognitions • Named One of America’s Best Employers for New Grads by Forbes (2024 • Named One of the Best Companies to Work for by U.S. News & World Report (Private Companies List, 2024-2025) • One of the Largest IT Staffing Firms in the US – Ranked #3 by Staffing Industry Analysts (SIA, 2024) • One of the Largest Staffing Firms in the US – Ranked #13 by Staffing Industry Analysts (SIA, 2024; includes Innova Solutions, Volt, & HireGenics) • Named One of the Top Ten Private Companies in Atlanta by the Atlanta Business Chronicle (2023) • One of the Largest Certified Minority Business Enterprises (MBEs) in the United States (NMSDC, 2024) • AWS Advanced Tier Services Partner with 100+ certifications Website: https://www.innovasolutions.com/ Innova Solutions offers a referral bonus for qualified Ambassadors who refer eligible referrals. Submit referrals at https://innovasolutions.workllama.com/atsuser/anonreferafriend and earn $250-$1,000 per referral. Innova Solutions is an Equal Opportunity Employer and prohibits any kind of unlawful discrimination and harassment. Innova Solutions is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment on the basis of race, color, religion or belief, national origin, citizenship, social or ethnic origin, sex, age, physical or mental disability, veteran status, marital status, domestic partner status, sexual orientation, or any other status protected by the statutes, rules, and regulations in the locations where it operates. If you are an individual with a disability and need a reasonable accommodation to assist with your job search or application for employment, please contact us at hr@innovasolutions.com or (770) 493-5588. Please indicate the specifics of the assistance needed. Innova Solutions encourages all interested and qualified candidates to apply for employment opportunities. Innova Solutions (HireGenics/Volt) does not discriminate against applicants based on citizenship status, immigration status, or national origin, in accordance with 8 U.S.C. • 1324b. The company will consider for employment qualified applicants with arrest and conviction records in a manner that complies with the San Francisco Fair Chance Ordinance, the Los Angeles Fair Chance Initiative for Hiring Ordinance, and other applicable laws. By applying for this job, you agree to receive calls, AI-generated calls, text messages, or emails from Innova Solutions and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy at Privacy Policy - innovasolutions.