The Business Consultant is responsible for facilitating regulatory audits that involve the Prior Authorization process. The facilitation of each audit includes, but is not limited to, determining data requirements, providing deliverables timely, presenting cases and answering process related questions during the audit. The applicant will possess full technical knowledge of the Prior authorization systems in order to identify deficiencies proactively, ahead of the audit. This position will specifically be responsible for handling Prior Authorization audit requests, and regulatory reporting for Medicare part D.

Location: This position will work a hybrid model (1 day in the office per week). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.

How you will make an impact:

• Work with our internal operations teams to understand current workflows and where improvements can be considered.

• Create reports for leadership around key performance indicators.

• Evaluate audit requirements.

• May lead teams of analysts assigned to complex projects.

• Determine audit risks.

• Analyze audit findings and regulatory reporting.

• Consult with business partners concerning audit findings to determine root cause/remediation.

Minimum Requirements:

• Requires a BA/BS and minimum of 8 years business analysis experience, which should include analysis and project management; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

• Knowledge of systems capabilities and business operations strongly preferred.

• Knowledge of SQL and/or Alteryx strongly preferred.

• Experience working with Medicare part D.