Senior Business Analyst – Pharmacy (RCM, Billing & Financial Reconciliation)
Job Description
Inovalon was founded in 1998 on the belief that technology, and data specifically, would empower the transformation of the entire healthcare ecosystem for the better, improving both outcomes and economics. At Inovalon, we believe that when our customers are successful in their missions, healthcare improves. Therefore, we focus on empowering them with data-driven solutions. And the momentum is building.
Together, as ONE Inovalon, we are a united force delivering solutions that address healthcare’s greatest needs. Through our mission-based culture of inclusion and innovation, our organization brings value not just to our customers, but to the millions of patients and members they serve.
Overview
We are seeking a highly experienced Senior Business Analyst with deep expertise in specialty/infusion pharmacy, medical billing, and financial reconciliation to support enterprise SaaS implementations. This role serves as a critical liaison between clients, operations, product, and engineering teams to define business requirements, design future-state workflows, and ensure successful delivery of Revenue Cycle Management (RCM) solutions.
The ideal candidate brings strong domain knowledge in pharmacy billing, claims adjudication, payment posting, and reconciliation, and plays a key role across the full client lifecycle—from pre-sales through implementation and post-go-live optimization.
Key Responsibilities
Delivery & Strategic Execution
- Lead complex and enterprise-wide implementations with multiple integrated workstreams
- Own RCM functional track deliverables, ensuring alignment across stakeholders
- Define governance standards, implementation plans, and risk mitigation strategies
- Drive future-state workflow design across pharmacy operations and revenue cycle processes
- Manage release coordination, dependencies, and cross-functional execution
Pharmacy Billing & Revenue Cycle Expertise
- Serve as Subject Matter Expert (SME) in:
- Medical and pharmacy billing (specialty and infusion)
- Claims lifecycle management (submission, adjudication, reversals, rebilling)
- Payment posting, ERA (835), and financial reconciliation
- Optimize workflows to improve:
- Clean claim rate and first-pass yield
- Denial management and resolution
- Days in Accounts Receivable (A/R)
- Net collections and revenue leakage prevention
- Analyze and resolve billing discrepancies including underpayments, overpayments, and unapplied cash
- Ensure alignment between pharmacy systems, billing platforms, clearinghouses, and financial systems
Client Engagement & Product Collaboration
- Work closely with clients to gather and define RCM and operational requirements
- Translate client needs into business and system requirements for product development
- Provide business case justification for product enhancements
- Participate across the full lifecycle:
- Request for Proposal (RFP )esponses and product demos
- Implementation, testing, and go-live
- Post-production support and optimization
- Partner with Product Managers on roadmap and knowledge sharing
Requirements & Process Analysis
- Elicit, document, and manage business and system requirements (BRDs, design documents)
- Develop process workflows using tools such as Visio
- Analyze current systems and identify improvement opportunities
- Assess impacts of proposed solutions across systems, workflows, and stakeholders
Technical & Data Capability
- Work within SaaS environments utilizing Agile/Scrum and full SDLC practices
- Support system configuration and ensure alignment with business requirements
- Define data requirements and support reporting and reconciliation processes
- Utilize tools such as SQL and Crystal Reports for data validation and analysis
- Support integrations across APIs, FHIR/HL7, claims (NCPDP/837), and remittance (835)
Validation & Quality Assurance
- Lead User Acceptance Testing (UAT) strategy, planning, and execution
- Participate in system validation prior to release
- Triage and resolve escalated defects in collaboration with QA and engineering
- Ensure delivered solutions meet client, operational, and financial expectations
Stakeholder & Leadership Responsibilities
- Act as a trusted advisor to clients and internal leadership
- Lead cross-functional discussions and align business and technical teams
- Support training initiatives and knowledge transfer
- Mentor junior analysts and promote BA best practices
Operational Excellence & Business Impact
- Drive improvements in onboarding, billing accuracy, and operational efficiency
- Support standardization, scalability, and adoption of solutions
Compliance & Governance
- Ensure adherence to HIPAA, DEA, State Board, and regulatory requirements
- Maintain compliance with Inovalon policies and procedures
- Support audit readiness and financial accuracy
Qualifications
Education
- Bachelor’s Degree in Healthcare, IT, Business, or related field (or equivalent experience)
Experience
- 5+ years of Business Analysis experience in healthcare or SaaS
- 2+ years of experience in medical billing and financial reconciliation
- Experience in specialty or infusion pharmacy environments preferred
- Strong background in Revenue Cycle Management (RCM)
Working Conditions
- Primarily sedentary role involving extended periods of sitting and computer use
- Occasional lifting (up to 10 pounds)
- Ability to work in a fast-paced, dynamic environment
- Travel for this position will include up to 10%
Inovalon Offers a Competitive Salary and Benefits Package
In addition to the base compensation, this position may be eligible for performance-based incentives.
The actual base pay offered may vary depending on multiple factors including, but not limited to, job-related knowledge/skills, experience, business needs, geographical location, and internal equity. At Inovalon, it is not typical for an individual to be hired at or near the top end of the range for their role, and compensation decisions are dependent upon the facts and circumstances of each position and candidate.
Inovalon invests in associates to help them stay healthy, save for long-term financial goals, and manage the demands of work and personal commitments. That’s why Inovalon offers a valuable benefits package with a wide range of choices to meet associate needs, which may include health insurance, life insurance, company-paid disability, 401k, 18+ days of paid time off, and more.
This position is not eligible for immigration sponsorship (e.g. H-1B, TN, or E-3). Applicants must be authorized to work in the United States as a condition of employment. (This is only applicable for US-based positions)
If you don’t meet every qualification listed but are excited about our mission and the work described, we encourage you to apply. Inovalon is most interested in finding the best candidate for the job, and you may be just the right person for this or other roles.
By embracing inclusion, we enhance our work environment and drive business success. Inovalon strives to provide equal opportunities to the communities where we operate and to our clients and everyone whom we serve. We endeavor to create a culture of inclusion in which our associates feel empowered to bring their full, authentic selves to work and pursue their professional goals in an equitable setting. We understand that by fostering this type of culture, and welcoming different perspectives, we generate innovation and growth.
Inovalon is proud to be an equal opportunity workplace. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or veteran status. We also consider qualified applicants regardless of criminal histories, consistent with legal requirement.
To review the legal requirements, including all labor law posters, please visit this link
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