Business Analyst

Infinite Computer Solutions; Georgia; On-site; USD 80,000 - 110,000; Full time

Job summary

Infinite Computer Solutions is seeking a UM Data Analyst to analyze utilization trends, claims data, and pharmacy data to identify cost-containment opportunities. The role includes documenting and improving UM workflows, defining IT requirements, and performing UAT for UM software.

The ideal candidate has 3-5+ years in UM or care management, strong SQL, and experience with Tableau/Power BI and EHR/EMR systems, plus knowledge of ICD-10/CPT coding and insurance regulations.

Qualifications

• 3-5+ years in UM, care management, or managed care settings.
• Strong SQL skills, data visualization tools (Tableau, Power BI), and EHR/EMR.
• Deep understanding of healthcare coding (ICD-10, CPT), claims, and insurance regulations.
• Bachelor’s degree in Healthcare Administration, Nursing, or related field.
• RN or LPN license is highly preferred for clinical data interpretation.

Responsibilities

• Data Analysis & Reporting: Analyze utilization trends, claims data, and pharmacy data to identify cost-containment opportunities.
• Workflow Optimization: Document, review, and enhance UM processes (intake, concurrent review, appeals).
• System Enhancement: Define business requirements for IT solutions and conduct user acceptance testing (UAT) for UM software.
• Regulatory Compliance: Ensure all UM processes comply with state/federal regulations and accreditation standards.
• Cross-functional Collaboration: Act as a liaison between clinical staff (nurses, medical directors) and IT/leadership.

Skills

SQL

Data visualization

EHR/EMR

Healthcare data analysis

Education

Bachelor’s degree in Healthcare Administration/Nursing/related

Tools

Tableau

Power BI

Excel

SAS

Visio

Job description

Job Description

Key Responsibilities

• Data Analysis & Reporting: Analyze utilization trends, claims data, and pharmacy data to identify cost-containment opportunities.
• Workflow Optimization: Document, review, and enhance UM processes (intake, concurrent review, appeals).
• System Enhancement: Define business requirements for IT solutions and conduct user acceptance testing (UAT) for UM software.
• Regulatory Compliance: Ensure all UM processes comply with state/federal regulations and accreditation standards.
• Cross-functional Collaboration: Act as a liaison between clinical staff (nurses, medical directors) and IT/leadership.

Required Skills and Qualifications

• Experience: 3-5+ years in UM, care management, or managed care settings.
• Technical Proficiency: Strong SQL skills, data visualization tools (e.g., Tableau, Power BI), and electronic health records (EHR/EMR).
• Knowledge: Deep understanding of healthcare coding (ICD-10, CPT), claims, and insurance regulations.
• Education: Bachelor’s degree in Healthcare Administration, Nursing, or related field.
• Clinical Background: RN or LPN license is highly preferred for clinical data interpretation.

Common Tools Used

• SQL and relational databases.
• Data analysis software (Excel, SAS, SQL).
• Workflow modeling tools (Visio).
• Reporting platforms (Tableau, Power BI).