Business Analyst, Optum CES

Business Analyst, Optum CES

Location: Remote

Employment Type: 1 month contract with possibility of extension

We are seeking a seasoned Business Analystwith deep expertise in Optum Claims Editing System (CES)and integration experience with Epic Tapestry. This individual will be responsible for driving CES configuration, edit implementation, and system alignment with Epic denial codes and benefit configurations. The role demands cross-functional collaboration, system analysis, and execution oversight to enhance claims adjudication workflows and ensure alignment with payer strategies.

Key Responsibilities:

• Collaborate with stakeholders including business leaders, claims operations, IT teams, and vendors to guide the end-to-end implementation of Optum CES.

• Analyze and document business requirements related to claims editing rules, benefit configuration, and adjudication logic.

• Design and validate system edits (e.g., age edits, duplicate logic, modifier rules) to ensure compliance with regulatory and payer-specific policies.

• Map and reconcile EDI transactions (837/835) with Epic Tapestry records to ensure accurate CES integration.

• Partner with configuration analysts to ensure benefit structures and payment policies align with claims editing logic.

• Lead and support functional testing, UAT, and defect resolution for CES edits and Epic denial workflows.

• Monitor project timelines, milestones, risks, and cross-functional dependencies to ensure on-time delivery.

• Identify and recommend process improvements to reduce manual intervention and enhance claims accuracy and provider experience.

Required Skills & Experience:

• Minimum 5 years of experience as a Business Analystin healthcare IT, with hands‑on implementation of Optum CES.

• Stong understanding of PPS reimbursement within the claims processing cycle.
• Experience with Epic Tapestrystrongly preferred.

• Proficiency in claims editing systems, claims adjudication logic, and healthcare EDI standards (837/835).

• Demonstrated ability to lead cross‑functional initiatives involving technical and business teams.

• Strong written and verbal communication skills, with the ability to translate complex technical details into business-friendly language.

• Exceptional organizational skills and a track record of managing high‑impact healthcare IT projects.

CoSourcing Partners is an equal opportunity employer committed to fostering an inclusive and diverse workplace. We do not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, genetic information, or any other protected status under applicable federal, state, or local laws.

We believe in creating a work environment where all employees feel valued, respected, and empowered to contribute to our success. Accommodations are available upon request for applicants with disabilities throughout the hiring process.

Join us and be part of a team that values diversity, equity, and inclusion.