We are seeking a Senior Business Analyst to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.
About the Role:
The Senior Business Analyst in Health Care Services plays a pivotal role in bridging the gap between clinical operations and technology solutions to enhance member care and organizational efficiency. This position is responsible for analyzing complex business processes, identifying areas for improvement, and designing effective strategies that align with healthcare regulations and standards. The role requires collaboration with cross-functional teams including clinical staff, IT professionals, and management to gather requirements and translate them into actionable project plans. The Senior Business Analyst will lead initiatives that drive data-driven decision-making and support the implementation of innovative healthcare solutions. Ultimately, this role ensures that business objectives are met while maintaining compliance and improving overall service delivery within the healthcare environment.
Minimum Qualifications:
- Associate's degree in Business Administration, Health Informatics, or a related field.
- At least 4 years of experience as a Business Analyst within the healthcare industry.
- Proficient knowledge of UB04 / CMS-1500 claim adjudication process, including Medicare and Medicaid reimbursement methodologies (i.e. Per Diem, PPS, FFS, APG, Capitation, etc.) required.
- Must possess good understanding of claim adjudication process including ICD, CPT, HCPCS
- Strong proficiency in business analysis tools and methodologies, including requirements gathering and process mapping.
- Relevant experience may substitute for the educational requirement on a year-for-year basis.
Preferred Qualifications:
- Bachelor's degree in Health Administration, Public Health, or a related discipline.
- Certification such as Certified Business Analysis Professional (CBAP) or Certified Healthcare Business Analyst (CHBA).
- Experience with Electronic Health Record (EHR) systems and healthcare data analytics platforms.
- Knowledge of healthcare quality improvement frameworks and member safety standards.
- Experience working in agile project environments.
Responsibilities:
- Maintain data integrity of provider set-ups and reimbursement configurations, including timely updates and troubleshooting.
- Load and implement practitioner, hospital, and ancillary contracts into the claims system, including amendments and claims testing.
- Program and maintain pricing setups based on contract specifications across various care settings (e.g., inpatient, outpatient, ER).
- Participate in client implementations, conversions, and internal/external meetings to support operational needs.
- Create documentation for workflows and policies and mentor staff on complex contract configurations.
Skills Required
- Associate's degree in Business Administration, Health Informatics, or related field (relevant experience may substitute year-for-year).
- At least 4 years of experience as a Business Analyst within the healthcare industry.
- Proficient knowledge of UB04 / CMS-1500 claim adjudication process, including Medicare and Medicaid reimbursement methodologies (Per Diem, PPS, FFS, APG, Capitation).
- Good understanding of claim adjudication process including ICD, CPT, HCPCS.
- Strong proficiency in business analysis tools and methodologies, including requirements gathering and process mapping.
- Bachelor's degree in Health Administration, Public Health, or related discipline.
- Certification such as Certified Business Analysis Professional (CBAP) or Certified Healthcare Business Analyst (CHBA).
- Experience with Electronic Health Record (EHR) systems and healthcare data analytics platforms.
- Knowledge of healthcare quality improvement frameworks and member safety standards.
- Experience working in agile project environments.
What We Do
Independent Living Systems, LLC, offers a comprehensive range of clinical and third-party administrative services to managed care organizations and providers that serve high-cost, complex member populations in the Medicare, Medicaid and Dual-Eligible Market. Independent Living Systems has been an industry leader in managing home and community-based programs for over 16 years. Leveraging ILS’ award winning technology platform, ILS provides assistance beyond the clinical realm at every stage of care from hospitalization to the treatment of chronic illnesses to personalized care management including nutritional support. As one of the country’s leading providers of Nutritional Support Services and medically tailored meals, ILS provides nutrition counseling and home delivered meals for individuals transitioning from acute settings to the home as well as for those combatting the effects of one or more chronic diseases. In partnership with health plans, providers, hospitals, and pharmaceutical and medical device companies, ILS provides solutions aimed at improving health outcomes while rebalancing costs. ILS’ suite of products and services include: MLTSS - Managed Long-Term Services Supports Suite of solutions including assessments, care management, and coordination of home and community-based services, care planning, and back-office support CCM - Comprehensive Care Management A streamlined solution for ongoing care management and care optimization targeted towards special needs populations and special needs plans Meals and Nutrition One of the nation’s largest nutritional providers delivering consistent, high-quality therapeutic meals to elderly and at-risk populations TPA – Third Party Administration A fully integrated business and technology offering to support all administrative and financial reporting requirements of health plans and risk bearing entities MSO – Management Services Organization Population and provider-based interventions to address utilization and monitor unit costs of services For more information please contact us via email at [email protected].
