Summary
We are seeking a motivated and analytically driven Business Analyst with a strong foundation in healthcare revenue cycle management to join our Prior Authorization and Enriched Claim Status Automation Product Team. In this role, you will partner closely with product managers to analyze complex datasets, identify growth opportunities, and drive the evolution of our automation solutions. Your work will be instrumental in delivering products that streamline revenue cycle operations and create measurable value for our healthcare clients. The ideal candidate brings 1-3 years of hands-on experience in healthcare revenue cycle environments, with demonstrated knowledge of prior authorization, admission notification workflows, and claim status processes from both provider and payer perspectives. You should have a solid understanding of the healthcare data landscape, including patient encounter data and standard EDI transaction sets (278 inquiry/response, 835/837, 276/277, 270/271, etc.), along with exposure to FHIR APIs and modern interoperability standards. Success in this role requires strong analytical capabilities, technical aptitude, and a customer-centric mindset—you must be comfortable translating data insights into actionable recommendations while keeping client needs at the forefront.
Responsibilities
- Analyze prior authorization and claim status datasets to identify trends, performance metrics, and improvement opportunities
- Conduct root cause analysis on process inefficiencies, claim denials, and authorization delays
- Research and analyze payer clinical policies, medical necessity criteria, and prior auth submission requirements
- Monitor customer feedback and product performance to identify enhancement opportunities
- Maintain current knowledge of industry standards, payer requirements, and regulatory changes affecting prior authorization workflows and claims processes
- Document and map complex healthcare workflows and identify pain points and automation opportunities
- Gather business requirements and create detailed user stories, process flows, and functional specifications
- Develop and maintain documentation of workflows, data specifications, and product features
- Partner with product managers to define and prioritize features based on data insights and customer needs
- Participate in product discovery sessions and contribute analytical perspectives
- Collaborate with implementation and support teams to identify, document, and resolve product issues and defects
- Communicate complex technical and analytical concepts effectively to both technical and non-technical audiences
Please note that this job description is not intended to be an exhaustive list of all responsibilities, expected outcomes, or qualifications associated with the role. Janus reserves the right to make changes and/or assign additional responsibilities of a role within reason at any time, with or without notice.
Qualifications
- Bachelor's degree in Business Administration, Computer Science, Healthcare Administration, or related field
- 1-3 years of experience working with prior authorization and admission notification workflow and claim status processes on the provider and payer sides
- Experience working with provider organizations, EHR systems, and RCM platforms; familiarity with EPIC is a plus
- Hands-on experience with AI applications, Payer Guidelines, and Clinical Documentation initiatives
- Strong critical thinking skills to address complex healthcare business challenges
- Strong data analytical skills, strong SQL and Excel proficiency preferred
- Comfortable creating and using process diagrams and flowcharts (MS Visio, Draw IO, etc.)
- Excellent written and verbal communication skills
- Ability to thrive in a fast-paced, dynamic environment with shifting priorities
- Knowledge of healthcare EDI transactions, including 278 X215/216/217, 837, 835, 276/277, and 270/271 EDI transactions
- Must be located in the United States; no sponsorship is available at this time
Travel Requirements
This role does occasionally require domestic travel. These travel expectations will be communicated by the department manager or executive. Janus is committed to providing as much flexibility and advanced notice as possible related to scheduling travel.
Physical Demands
This job is operated in a professional remote or in-office environment. This job uses standard office equipment. This job is largely a sedentary role; however, the employee has the flexibility to move as needed. Constantly operates a computer, phone, keyboard, mouse, and other office equipment. The employee frequently communicates with internal and/or external people. Must be able to exchange accurate information in a timely manner. Must be able to recognize objects from short and long distances.
Equal Opportunity Statement
Janus is an equal opportunity employer. We hire great people from a wide variety of backgrounds and appreciate our differences. We welcome the unique contributions that you can bring in terms of your education, opinions, culture, ethnicity, race, ancestry, sex, gender identity and expression, national origin, citizenship, marital status, age, languages spoken, veteran status, color, religion, disability, sexual orientation, and beliefs.
We consider qualified applicants regardless of criminal histories, consistent with legal requirements. Further, consistent with applicable federal and state law, Janus provides reasonable accommodation when requested by qualified applicants or employees with disabilities, unless doing so would cause an undue hardship. Janus’ policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If you require reasonable accommodation, please contact the Operations Team.
At Janus, we believe in a world where healthcare functions efficiently. Join us on our mission to improve the lives of administrative workers and fundamentally change the way work is done. Our team is building a world-class process improvement platform to help healthcare providers generate more cash with less resources.
Our employees are our greatest asset, and we are passionate about creating strong culture with deep purpose. We are entrepreneurial and focused, yet humble, empathetic and inclusive. We value the individual and tackle problems as a team. The best idea wins, and teams celebrate together.