Code Editor Business Systems Analyst (Optum CES)

We are seeking an experienced Business Systems Analyst with deep expertise in the Optum Claims Editing System (CES) and integration experience with Facets and Epic Tapestry. This role will be responsible for driving CES configuration, claims edit implementation, and system alignment initiatives to improve claims adjudication processes and support payer business strategies.

The ideal candidate has strong business analysis experience, understands healthcare claims processing, and can collaborate across technical and business teams to gather requirements, analyze workflows, troubleshoot issues, and oversee implementation efforts. This individual will play a key role in ensuring Optum CES, Facets, and Epic Tapestry are aligned to support efficient and accurate claims processing.

Key Responsibilities

• Lead business analysis activities for Optum Claims Editing System (CES) initiatives.
• Configure and support Optum CES claims edits and system alignment efforts.
• Partner with stakeholders to implement and optimize claims editing rules and adjudication workflows.
• Analyze existing business processes and identify opportunities for workflow improvements and system optimization.
• Gather, document, and validate business and functional requirements.
• Define system scope and objectives through research, analysis, and understanding of healthcare business processes.
• Collaborate with business users, developers, and cross-functional teams throughout the project lifecycle.
• Support integration efforts involving Optum CES, Facets, and Epic Tapestry.
• Troubleshoot issues within existing systems and coordinate resolution with technical teams.
• Review existing system logic and recommend enhancements or modifications.
• Participate in multiple phases of the Systems Development Life Cycle (SDLC), including:
  • Requirements gathering
  • Functional analysis
  • Solution design
  • Testing support
  • Implementation
  • Post-production support
• Stay current on healthcare industry trends, payer requirements, and technology changes that may impact existing systems.
• Provide guidance and mentorship to less experienced Business Systems Analysts when appropriate.

Required Qualifications

• Associate's degree, technical school certification, or equivalent experience.
• Minimum 2 years of Business Systems Analyst experience or related experience.
• Experience with Optum Claims Editing System (CES).
• Experience integrating or working with Facets.
• Experience integrating or working with Epic Tapestry.
• Experience supporting healthcare claims adjudication workflows.
• Strong business analysis, workflow analysis, and requirements gathering skills.
• Experience documenting business and functional requirements.
• Ability to analyze existing systems and recommend process improvements.
• Experience collaborating with technical and business stakeholders.
• Strong analytical, troubleshooting, and problem-solving skills.
• Excellent written and verbal communication skills.

Preferred Qualifications

• Bachelor's degree or equivalent experience.
• 3+ years of relevant Business Systems Analyst experience.
• Experience defining system scope and business objectives.
• Experience throughout the Systems Development Life Cycle (SDLC), including requirements gathering and solution design.
• Experience participating in multiple phases of an integrated system implementation.
• Background in:
  • Healthcare
  • Health insurance or payer organizations
  • Healthcare information systems
  • Health sciences
• Experience with healthcare claims editing and payment integrity initiatives.
• Knowledge of healthcare industry standards and claims processing best practices.

Desired Skills

• Optum Claims Editing System (CES)
• Facets
• Epic Tapestry
• Claims adjudication
• Claims editing configuration
• Healthcare payer operations
• Business Systems Analysis
• Business process analysis
• Workflow analysis and optimization
• Requirements gathering
• Functional requirements documentation
• System analysis
• SDLC
• Integrated system implementations
• Troubleshooting
• Cross-functional collaboration
• Healthcare information systems
• Process improvement
• Analytical problem solving
• Communication and stakeholder management

This role is ideal for a Business Systems Analyst with healthcare payer experience who can bridge business and technical teams while driving successful claims editing and system integration initiatives.

NO C2C