Inovalon
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Business Rules Support Analyst
role at
Inovalon .
Job Summary The Business Rules Support Analyst will provide in-depth analysis and creation of healthcare provider business rules that modify and edit medical claims. The role requires strong knowledge of medical billing, coding of insurance claims, and experience as a biller or in a clearinghouse. The analyst will be customer‑facing via email, ticketing, and occasional video meetings.
Key responsibilities include reviewing customer requests, clarifying requirements, creating, testing, and publishing custom claim edits within SLAs, and researching payer compliance standards. The analyst works with application support, engineering teams, and internal departments to maintain high first‑pass claim acceptance rates.
Responsibilities
Triage incoming internal and external customer requests for medical claim processing changes.
Prioritize requests and resolve issues promptly.
Develop technical business rules to process medical claims, including building logic statements, testing, and deploying to live systems.
Collaborate with application support to triage production problems, perform defect analysis, and provide fixes.
Work with other Inovalon departments to deliver fit‑for‑purpose solutions.
Coordinate with Technology and Engineering to resolve application issues and enhance internal tools.
Ensure compliance with company procedures when implementing new rules.
Execute scheduled compliance updates timely.
Research payer websites and standards (e.g., UB Editor, payer Companion Guides).
Identify and implement new rules for claim‑level and file‑level failures to maintain acceptance rate targets.
Update documentation, SOPs, and training materials.
Follow up on unresolved issues.
Respond to support requests via phone and email.
Assist operations with process improvement and business problem solutions.
Maintain compliance with Inovalon’s policies, procedures, mission statement, confidentiality, HIPAA, and other operational safeguards.
Requirements
Minimum 2 years’ experience with medical billing in a healthcare setting (doctor’s office, hospital, or clearinghouse).
Understanding of Medicare NCDs, Medicare/Medicaid MUE, and CCI billing rules.
Solid knowledge of Institutional and Professional claim forms, 5010 X12 files (837, 835, 277, 999).
Experience building logic rules for medical claim processing.
Excellent problem‑solving and analytical skills.
Strong client communication skills.
Experience with ticketing systems, preferred: ServiceNow.
Ability to multi‑task effectively.
Preferred Qualifications
Background in application support or SaaS environments.
Experience with Clearhouse backend operations.
Healthcare industry experience.
Education Bachelor’s degree or equivalent work experience required.
Physical Demands and Work Environment
Primarily sedentary office work; occasional lifting up to 10 pounds.
Work may require repetitive motions and environmental conditions inside the office.
Local travel up to 5% for training and meetings.
Compensation and Benefits
Base compensation range: $56,000—$75,000 USD.
Potential for performance‑based incentives.
Benefits include health insurance, life insurance, company‑paid disability, 401(k), paid time off, and more.
Position not eligible for immigration sponsorship.
Equal Employment Opportunity Inovalon is committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or veteran status. We consider qualified applicants regardless of criminal histories, consistent with legal requirements. Inovalon strives to create a supportive, inclusive culture where every associate feels empowered to bring their authentic selves to work.
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Business Rules Support Analyst
role at
Inovalon .
Job Summary The Business Rules Support Analyst will provide in-depth analysis and creation of healthcare provider business rules that modify and edit medical claims. The role requires strong knowledge of medical billing, coding of insurance claims, and experience as a biller or in a clearinghouse. The analyst will be customer‑facing via email, ticketing, and occasional video meetings.
Key responsibilities include reviewing customer requests, clarifying requirements, creating, testing, and publishing custom claim edits within SLAs, and researching payer compliance standards. The analyst works with application support, engineering teams, and internal departments to maintain high first‑pass claim acceptance rates.
Responsibilities
Triage incoming internal and external customer requests for medical claim processing changes.
Prioritize requests and resolve issues promptly.
Develop technical business rules to process medical claims, including building logic statements, testing, and deploying to live systems.
Collaborate with application support to triage production problems, perform defect analysis, and provide fixes.
Work with other Inovalon departments to deliver fit‑for‑purpose solutions.
Coordinate with Technology and Engineering to resolve application issues and enhance internal tools.
Ensure compliance with company procedures when implementing new rules.
Execute scheduled compliance updates timely.
Research payer websites and standards (e.g., UB Editor, payer Companion Guides).
Identify and implement new rules for claim‑level and file‑level failures to maintain acceptance rate targets.
Update documentation, SOPs, and training materials.
Follow up on unresolved issues.
Respond to support requests via phone and email.
Assist operations with process improvement and business problem solutions.
Maintain compliance with Inovalon’s policies, procedures, mission statement, confidentiality, HIPAA, and other operational safeguards.
Requirements
Minimum 2 years’ experience with medical billing in a healthcare setting (doctor’s office, hospital, or clearinghouse).
Understanding of Medicare NCDs, Medicare/Medicaid MUE, and CCI billing rules.
Solid knowledge of Institutional and Professional claim forms, 5010 X12 files (837, 835, 277, 999).
Experience building logic rules for medical claim processing.
Excellent problem‑solving and analytical skills.
Strong client communication skills.
Experience with ticketing systems, preferred: ServiceNow.
Ability to multi‑task effectively.
Preferred Qualifications
Background in application support or SaaS environments.
Experience with Clearhouse backend operations.
Healthcare industry experience.
Education Bachelor’s degree or equivalent work experience required.
Physical Demands and Work Environment
Primarily sedentary office work; occasional lifting up to 10 pounds.
Work may require repetitive motions and environmental conditions inside the office.
Local travel up to 5% for training and meetings.
Compensation and Benefits
Base compensation range: $56,000—$75,000 USD.
Potential for performance‑based incentives.
Benefits include health insurance, life insurance, company‑paid disability, 401(k), paid time off, and more.
Position not eligible for immigration sponsorship.
Equal Employment Opportunity Inovalon is committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or veteran status. We consider qualified applicants regardless of criminal histories, consistent with legal requirements. Inovalon strives to create a supportive, inclusive culture where every associate feels empowered to bring their authentic selves to work.
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