Business Information Consultant

Anticipated End Date:

2025-06-02

Position Title:

Business Information Consultant

Job Description:

Business Information Consultant

Location: Ideal candidates will live or be willing to relocate to within 50 miles of our Pulse Point location in 5800 Northampton Blvd., Norfolk, VA 23502

Work Hours:    Monday to Friday, 8:00 am to 5:00 pm

The Business Information Consultant develops specifications and requirements for the submission of health care medical encounter data files which meet ANSI X12 data criteria, are HIPAA compliant, and meet state Medicaid and federal Medicare guidelines as expressed in companion guides and technical specifications. These include ANSI X12 transactions 837P, 837I, 837D, 835, 270, 271, 276, 277 and 999 for encounter reporting.

How you will make an impact:

• Work on Medicaid encounters submission to Ohio, Indiana and NJ state and reconcile the remits received from state.

• Analyze pends, rejects, completeness, accuracy reports and share with stakeholders.

• Gather business requirements to eliminate internal exception as well as external exception codes. 

• Work with Encounters IT team to assist with change requests which includes preparing the requirements, testing documentation, completing the 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. 

• May require taking business issue and devising best way to develop appropriate diagnostic and/or tracking data that will translate business requirements into usable decision support tools.

Minimum Requirements:

• Bachelor’s degree in Computer Science, or related.

• Five (5) years in any occupation with IT experience.

Additional Requirements:

• Five (5) years in any occupation with IT experience must include: SQL and/or any other similar query language; Defect tracking tools.

• Health care data models.

• Encounter reporting using the 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 EDUCATION/EXPERIENCE REQUIREMENTS: Employer will accept a Master’s degree in Computer Science, or related, and three (3) years in any occupation with IT experience. Must have skills listed above.

SALARY:    $118,435 per year

APPLY:       https://careers.elevancehealth.com/ 

Job Level:

Non-Management Exempt

Workshift:

Job Family:

RDA > Business/Health Info

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [email protected] for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.