Healthcare Business Analyst

Job Title: Business Analyst (Hybrid) Location: Cerritos, CA | Pay: 44.28/hr *Please include your Linkedin on your resume

• Job Description: The ideal candidate will possess strong analytical capabilities, hands-on experience with the Availity portal and clearinghouse integrations, and the ability to collaborate effectively with business, operations, and technical stakeholders across distributed teams. Responsibilities: Conduct end-to-end analysis of payer and provider workflows involving Availity transactions, including Eligibility & Benefits (270/271), Claims Status (276/277), Prior Authorization (278), Attachments, and Claims (837/835). Evaluate business requirements, integration patterns, and data flows to ensure alignment with Availity capabilities and enterprise operational needs. Review Availity response data, error codes, payer-specific rules, and transaction exceptions for accuracy, completeness, and compliance with EDI standards. Support implementation, enhancement, and optimization of Availity portal features, API integrations, and clearinghouse configurations. Lead requirement-gathering sessions with operations, product teams, and technical stakeholders; document functional requirements, user stories, acceptance criteria, and workflow diagrams. Assess the business impact of Availity-related changes, EDI mapping updates, and upstream/downstream process modifications. Perform root cause analysis for transaction failures, rejections, eligibility discrepancies, and authorization processing issues. Develop test plans, execute UAT, and validate end-to-end transaction integrity for Availity workflow enhancements. Prepare documentation, reports, analysis logs, and communication materials for both technical and non-technical audiences. Conduct research and evaluate clearinghouse rules, EDI compliance requirements, and payer implementation guides. Provide SME-level guidance to project teams and serve as a resource for Availity operations, payer provider transactions, and healthcare EDI standards. Qualifications: Bachelor s degree in Healthcare Administration, Information Systems, Business, or a related field. Minimum 5 years of experience as a Healthcare Business Analyst within a payer or provider environment. Hands-on experience with Availity Portal, Availity APIs, or clearinghouse integrations required. Strong understanding of HIPAA-standard EDI transactions (270/271, 276/277, 278, 837, 835) and healthcare administrative processes. Experience documenting business requirements, process flows, and business rules related to eligibility, claims, and authorizations. Knowledge of healthcare data protection requirements and payer/provider transaction guidelines. Experience supporting business operations, compliance reviews, or audit activities in a healthcare environment. Ability to analyze transaction data, troubleshoot integration issues, and interpret Availity error responses and payer communications. Excellent written and verbal communication skills with the ability to create clear documentation and present findings effectively. Comfort working with cross-functional, U.S.-based teams and engaging directly with business stakeholders. Proficiency with MS Word, MS Excel, JIRA, Confluence, and standard EDI/Availity reporting tools.