Senior Business Analyst - Pharmacy (RCM, Billing & Financial Reconciliation)

About the role

We are seeking a highly experienced Senior Business Analyst with deep expertise in specialty/infusion pharmacy, medical billing, and financial reconciliation to support enterprise SaaS implementations. This role serves as a critical liaison between clients, operations, product, and engineering teams to define business requirements, design future-state workflows, and ensure successful delivery of Revenue Cycle Management (RCM) solutions. The ideal candidate brings strong domain knowledge in pharmacy billing, claims adjudication, payment posting, and reconciliation , and plays a key role across the full client lifecycle-from pre-sales through implementation and post-go-live optimization.

Responsibilities

• Delivery & Strategic Execution
• Lead complex and enterprise-wide implementations with multiple integrated workstreams
• Own RCM functional track deliverables, ensuring alignment across stakeholders
• Define governance standards, implementation plans, and risk mitigation strategies
• Drive future-state workflow design across pharmacy operations and revenue cycle processes
• Manage release coordination, dependencies, and cross-functional execution
• Pharmacy Billing & Revenue Cycle Expertise
• Serve as Subject Matter Expert (SME) in:
• Medical and pharmacy billing (specialty and infusion)
• Claims lifecycle management (submission, adjudication, reversals, rebilling)
• Payment posting, ERA (835), and financial reconciliation
• Optimize workflows to improve:
• Clean claim rate and first-pass yield
• Denial management and resolution
• Days in Accounts Receivable (A/R)
• Net collections and revenue leakage prevention
• Analyze and resolve billing discrepancies including underpayments, overpayments, and unapplied cash
• Ensure alignment between pharmacy systems, billing platforms, clearinghouses, and financial systems
• Client Engagement & Product Collaboration
• Work closely with clients to gather and define RCM and operational requirements
• Translate client needs into business and system requirements for product development
• Provide business case justification for product enhancements
• Participate across the full lifecycle:
• Request for Proposal (RFP )esponses and product demos
• Implementation, testing, and go-live
• Post-production support and optimization
• Partner with Product Managers on roadmap and knowledge sharing
• Requirements & Process Analysis
• Elicit, document, and manage business and system requirements (BRDs, design documents)
• Develop process workflows using tools such as Visio
• Analyze current systems and identify improvement opportunities
• Assess impacts of proposed solutions across systems, workflows, and stakeholders
• Technical & Data Capability
• Work within SaaS environments utilizing Agile/Scrum and full SDLC practices
• Support system configuration and ensure alignment with business requirements
• Define data requirements and support reporting and reconciliation processes
• Utilize tools such as SQL and Crystal Reports for data validation and analysis
• Support integrations across APIs, FHIR/HL7, claims (NCPDP/837), and remittance (835)
• Validation & Quality Assurance
• Lead User Acceptance Testing (UAT) strategy, planning, and execution
• Participate in system validation prior to release
• Triage and resolve escalated defects in collaboration with QA and engineering
• Ensure delivered solutions meet client, operational, and financial expectations
• Stakeholder & Leadership Responsibilities
• Act as a trusted advisor to clients and internal leadership
• Lead cross-functional discussions and align business and technical teams
• Support training initiatives and knowledge transfer
• Mentor junior analysts and promote BA best practices
• Operational Excellence & Business Impact
• Drive improvements in onboarding, billing accuracy, and operational efficiency
• Support standardization, scalability, and adoption of solutions
• Compliance & Governance
• Ensure adherence to HIPAA, DEA, State Board, and regulatory requirements
• Maintain compliance wi

Benefits

Additional Information

Inovalon was founded in 1998 on the belief that technology, and data specifically, would empower the transformation of the entire healthcare ecosystem for the better, improving both outcomes and economics. At Inovalon, we believe that when our customers are successful in their missions, healthcare improves. Therefore, we focus on empowering them with data-driven solutions. And the momentum is building. Together, as ONE Inovalon, we are a united force delivering solutions that address healthcare's greatest needs. Through our mission-based culture of inclusion and innovation, our organization brings value not just to our customers, but to the millions of patients and members they serve. Location: This position is designated as remote. However, employees who reside within a 40-mile radius of one of our office locations in Tampa, FL; Canonsburg, PA; or Bowie, MD will follow a hybrid work schedule and are expected to work in the office two days per week (Tuesdays and Wednesdays).

Your Match

How well this role fits your profile.

Company Intel

What employees say

Worked at inovalon? Share your experience