Business Information Consultant at Elevance Health

Norfolk, Virginia, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Health InsuranceIndustries

Requirements

Bachelor’s degree in Computer Science or related field
Five (5) years in any occupation with IT experience, including: SQL and/or any other similar query language; Defect tracking tool(s); Health care data models; Encounter reporting using ANSI X12 standards with delegated vendors such as transportation, dental, vision, and chiropractic; End-to-end testing from source data through enterprise applications; Edifecs EM application’s technical and workflow experience; Experience in different X12 transactions and reconciliation of data; Facets data model and application experience
Alternate: Master’s degree in Computer Science or related, and three (3) years in any occupation with IT experience with the skills listed above
Ability to report to 5800 Northampton Blvd., Norfolk, VA 23502 (within reasonable commuting distance; in-office 1-2 days per week)

Responsibilities

Develop specifications and requirements for submission of health care medical encounter data files meeting ANSI X12 data criteria, HIPAA compliant, and state Medicaid/federal Medicare guidelines (including companion guides and technical specifications for ANSI X12 transactions 837P, 837I, 837D, 835, 270, 271, 276, 277, and 999)
Work on Medicaid encounters submission to Ohio, Indiana, and NJ states and reconcile remits received from states
Analyze pends, rejects, completeness, accuracy reports and share with stakeholders
Gather business requirements to eliminate internal and external exception codes
Work with Encounters IT team to assist with change requests, including preparing requirements, testing documentation, completing mapping, and assisting with system and state testing
Produce high quality requirement specifications to support systems functional design development
Develop and analyze business performance reports (e.g., for claims data, provider data, utilization data) and provide notations of performance deviations and anomalies
Provide analytic consultation to other business areas, leadership, or external customers
Analyze data and summarize performance using summary statistical procedures
Devise best way to develop appropriate diagnostic and/or tracking data that translates business requirements into usable decision support tools

Skills

ANSI X12

HIPAA

837P

837I

837D

835

270

271

276

277

999

Medicaid

Medicare

Companion Guides

Requirements Gathering

Stakeholder Analysis

Change Requests

Testing Documentation

Claims Processing

Elevance Health

Integrated health services and digital platform

About Elevance Health

Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.

Indianapolis, IndianaHeadquarters

1944Year Founded

$309.4MTotal Funding

IPOCompany Stage

Enterprise Software, Social Impact, HealthcareIndustries

10,001+Employees

Benefits

Medical, dental, & vision insurance

401(k) + match

Paid holidays

Paid Time Off

Incentive bonus programs

Stock purchase plan

Life insurance

Wellness Programs

Financial education resources

Adoption & Surrogacy Assistance

Dependent-care Flexible Spending Account (DCFSA)

Parental Leave

Parental Transition Week

Critical Caregiving Leave

Risks

Departure of CFO John Gallina may create a gap in financial leadership.

Lawsuit against CMS over MA Star Ratings could lead to financial penalties.

CareBridge integration may face operational challenges, disrupting service delivery.

Differentiation

Elevance Health integrates whole health approach with digital health platform for comprehensive care.

Acquisition of CareBridge enhances home health services within Carelon division.

Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.

Upsides

AI integration in home health services can reduce hospital readmissions and improve outcomes.

Predictive analytics support early disease detection, aligning with Elevance's whole health approach.

Telehealth expansion offers opportunities to reach more patients remotely.

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