Anticipated End Date:
2026-01-21Position Title:
Provider Outreach Business Analyst IIJob Description:
Provider Outreach Business Analyst II
Hybrid: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
The Provider Outreach Business Analyst II is responsible for conducting outbound calls to healthcare providers to verify the accuracy of billed services and ensure claims were submitted and processed appropriately. The analyst will assess the validity of each recovery request, determine if recovery is appropriate, and identify potential opportunities for new recovery leads. This role requires strong attention to detail, foundational claims knowledge, and the ability to follow established procedures to determine the validity of claims prior to initiating contact with providers.
How you will make an impact:
Conduct outbound provider calls to confirm that services were rendered, and that the provider was expecting payment.
Review claim details to determine claim validity before initiating outreach, ensuring all required information is accurate and complete.
Meet or exceed daily outbound call attempt requirements as established by departmental performance metrics.
Maintain a QA (Quality Assurance) score of 95% or higher, demonstrating adherence to process, accuracy in documentation, and professionalism in communication.
Meet all Service Level Agreement (SLA) requirements related to outreach, documentation, and productivity.
Provide excellent customer service when interacting with providers, addressing questions politely and professionally.
Follow Desk Level Procedures (DLPs), workflows, and operational guidelines to ensure consistency and compliance in all outreach activities.
Accurately document call outcomes and follow-up activities in required systems.
Review and evaluate payment integrity recovery requests from external partners to determine validity and appropriateness.
Analyze claim data to confirm recovery eligibility using applicable CPT, HCPCS, and ICD-10 codes.
Utilize systems such as Facets and Macess to research claims, validate overpayments, and document findings.
Collaborate with internal teams to clarify claim details and ensure accurate communication with partners.
Prepare and maintain detailed documentation supporting recovery decisions.
Provide recommendations for process improvement and assist with the implementation of corrective actions.
Ensure compliance with all internal policies, regulatory requirements, and partner agreements.
Minimum Requirements:
Requires a BA/BS and minimum of 3 years related business analysis experience, or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities, and Experiences:
2–4 years of experience in healthcare claims analysis, payment integrity, or related field strongly preferred.
Proficient in Facets, Macess, and Microsoft Office Suite (Excel, Word, Outlook) preferred.
Experience in medical claims processing workflows and systems preferred.
Experience in payment integrity or claims recovery functions within a health insurance or managed care environment strongly preferred.
Prior experience identifying or developing new recovery leads preferred.
Familiarity with data analysis or query tools (e.g., SQL, Tableau, or similar) preferred.
If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a 'sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.
Job Level:
Non-Management ExemptWorkshift:
1st Shift (United States of America)Job Family:
BSP > Business SupportPlease be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.