Operations Business Analyst – Healthcare Claims (Remote)

Fortuna BMC; Texas; Remote; Full time

Job summary

A leading company is seeking a detail-oriented Operations Business Analyst for healthcare claims operations, focusing on accounts receivable reconciliation and payment processes. This fully remote role offers an opportunity to support the healthcare revenue cycle while contributing to documenting business requirements and improving operational processes.

Benefits

Paid sick leave

Medical, dental, and vision coverage

Free TeleMedicine and Mental Health services

Various insurance options available

Qualifications

• Bachelor's degree in Business, Healthcare Administration or Finance, or 3-5 years experience.
• Proficiency in SQL and understanding of claims adjudication.
• Excellent communication and organizational skills.

Responsibilities

• Post payments and reconcile accounts receivable based on EOBs.
• Analyze and resolve errors in claim postings.
• Develop systems requirements documentation to meet client needs.

Skills

Critical thinking

Problem-solving

Attention to detail

Communication

Education

Bachelor's degree in Business, Healthcare Administration, or Finance

Tools

SQL

PeopleSoft Finance

Job description

Operations Business Analyst – Healthcare Claims (Remote)

We are seeking a motivated and detail-oriented Operations Business Analyst to support our healthcare revenue cycle operations. In this role, you will be responsible for daily posting and reconciliation of accounts receivable (AR) based on electronic and paper Explanation of Benefits (EOBs) received from insurance carriers. You'll identify and correct posting discrepancies, ensure accurate application of payments to claims, and generate monthly invoices aligned with processed claims.

WORKSITE: Fully Remote- Open to Texas residents only

WORK SCHEDULE: Monday-Friday 8:00 AM - 4:30 PM or 9:00 AM - 5:00 PM

COMPENSATION: $19.00 Per Hour

WHAT WE OFFER:

Paid sick leave based on state regulations after 90 days of employment

Medical, dental, and vision are offered after a waiting period (60% paid by Fortuna)

Free TeleMedicine and Mental Health for all employees and their families

Additional volunteer options such as Group Life Insurance, Accidental Insurance, Critical Care, Short Term Disability

WHAT YOU'LL DO:

Post payments to medical and pharmacy claims from paper and electronic EOBs daily.

Reconcile AR and correct any discrepancies or posting issues.

Identify, analyze, and resolve errors in claim postings and payments.

Participates in meetings with client engagement to gather and document requirements and explore potential solutions.

Assists in analyzing and documenting client's business requirements and processes following established approach and methodology; communicates these requirements to technical personnel.

Plans and designs standard business processes following established approach and methodology; assists in formulating recommendations to improve and support business activities.

Develops and modifies systems requirements documentation to meet client needs.

Generate and distribute monthly invoices using PeopleSoft Finance based on claims posted during the reporting period.

Create, run, and deliver posting and reconciliation reports; analyze trends and anomalies.

Use FTP protocols to securely transfer files from various sources.

Maintain accurate documentation for audit and compliance purposes.

Collaborate with other departments to resolve issues related to claims and payments.

Work independently in a remote environment while meeting deadlines and service level agreements (SLAs).

WHAT YOU'LL BRING:

Bachelor's degree in Business, Healthcare Administration, Finance, or a related field; OR 3-5 years of experience in medical claims posting and reconciliation.

Solid understanding of medical and pharmacy claims adjudication and Medicaid reclamation claims.

Proficiency in SQL and ability to extract and analyze data from relational databases.

Familiarity with PeopleSoft Finance or similar enterprise financial systems.

Strong critical thinking and problem-solving skills; able to troubleshoot independently.

Experience with FTP protocols and secure file transfer.

Excellent written and verbal communication skills.

Strong attention to detail and organizational skills.

Fortuna operates as a staffing agency that sources, screens, and presents potential candidates for employment opportunities on behalf of our clients.

Fortuna was founded in 2012 by practicing professionals with more than 50 combined years of experience. Our headquarters is in McClellan, California with offices in Los Angeles and New York, and satellite offices in the Philippines and Israel. Fortuna is an active member of multiple California service agreements, including the CMAS, ITMSA (Tier 2), and CalPERS SpringFed Pool, as well as various municipalities and large corporation vendor pools

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