Business Analyst - New York, United States - Capital Rx

Capital Rx
Capital Rx
Verified Company
New York, United States

1 month ago

Mark Lane

Posted by:

Mark Lane

beBee recruiter
Description

Location:
Remote (For Non-Local) or Hybrid (Local to NYC area)


Position Summary:


This high-performing individual will be responsible for supporting the delivery of new features and functionality for JUDI, Capital Rx's enterprise health platform, to enable adjudication of Medical claims.


Position Responsibilities:


  • Collaborate with the Product Manager to build business requirements and specifications for road mapped items as directed by the Product Manager, including functionality to:
  • Process complex medical claims (professional and institutional) accurately and timely
  • Ensure that proper benefits are applied to each claim
  • Determine proper adjudication of primary and secondar payer claims
  • Review, research and solve challenges to process medical claims.
  • Intake product requests from operations stakeholders and clients.
  • Work with operations teams to manage issue prioritization and resolution.
  • Responsible for ticket review and identification of missed intent post Quality Assurance review.
  • Identify and make datadriven recommendations to Product Manager for high value product enhancements.
  • Assist Product Manager & team with user experience testing, research, documentation, and stakeholder communication.
  • Partner with Product Manager to manage backlog and participate in team refinement & planning.
  • Provide support to the Product Manager and team in terms of planning, roadmap development, and longterm strategy.
  • Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance.

Minimum Qualifications:


  • Bachelor's degree strongly preferred
  • 2+ years of work experience as a medical coder at a payer or TPA
  • Wellversed in CPT, ICD10, HCPCS codes
  • Demonstratable knowledge of Excel
  • Excellent communication and collaboration skills
  • Strong attention to detail
  • Comfort or experience in a fastpaced, growing environment
  • Intellectual and professional curiosity

Preferred Qualifications

  • CPC (Certified Professional Coder) preferred
  • Medicare/Medicaid experience
  • Familiarity with the agile framework/Certified Scrum Product Owner

Base Salary:
$75,000 - $85,000


_Nothing in this position description restricts management's right to assign or reassign duties and responsibilities to this job at any time. _

About Capital Rx

  • Capital Rx is a fullservice pharmacy benefit manager (PBM) and pharmacy benefit administrator (PBA), advancing our nation's electronic healthcare infrastructure to improve drug price visibility and patient outcomes. As a Certified B Corp, Capital Rx is executing its mission through the deployment of JUDI, the company's cloudnative enterprise health platform, and a Single-Ledger Model, which increases visibility and reduces variability in drug prices. JUDI connects every aspect of the pharmacy ecosystem in one efficient, scalable platform, servicing millions of members for Medicare, Medicaid, and commercial plans. Together with its clients, Capital Rx is reimagining the administration of pharmacy benefits and rebuilding trust in healthcare. _

_Capital Rx values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. _
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