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

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.

Overview

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.

Key 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 with Inovalon policies and procedures

Support audit readiness and financial accuracy

Qualifications

Education

Bachelor’s Degree in Healthcare, IT, Business, or related field (or equivalent experience)

Experience

5+ years of Business Analysis experience in healthcare or SaaS

2+ years of experience in medical …