Find similar career opportunities Senior Analyst, Edits | Payment Integrity (Remote) Category: Analytics and Emerging Digital Technologies Main location: United States, Tennessee, Knoxville Alternate ...
Find similar career opportunities Senior Analyst, Edits | Payment Integrity (Remote) Category: Analytics and Emerging Digital Technologies Main location: United States, Tennessee, Knoxville Alternate ...
Note: * This is a remote, work-from-home position, but the final round of interviews will take place on-site in our Chattanooga, TN office. * Sponsorship is not available for this role. Job ...
Note: * This is a remote, work-from-home position, but the final round of interviews will take place on-site in our Chattanooga, TN office. * Sponsorship is not available for this role. Job ...
Note: * This is a remote, work-from-home position, but the final round of interviews will take place on-site in our Chattanooga, TN office. * Sponsorship is not available for this role. Job ...
Note: * This is a remote, work-from-home position, but the final round of interviews will take place on-site in our Chattanooga, TN office. * Sponsorship is not available for this role. Job ...
Remote Bsa information
What is a remote BSA?
Remote BSA roles refer to Business Systems Analysts who work from remote locations rather than a traditional office. These professionals analyze business needs, design solutions, and bridge the gap between business stakeholders and IT teams, all while working remotely. Their tasks often include gathering requirements, documenting processes, and ensuring technology solutions meet business objectives. Working remotely requires strong communication skills, self-motivation, and proficiency with digital collaboration tools.
What are the key skills and qualifications needed to thrive as a remote BSA?
To thrive as a Remote Business Systems Analyst, you need strong analytical skills, experience in requirements gathering, and a solid understanding of business processes, often supported by a degree in business, IT, or a related field. Familiarity with tools like SQL, UML, and project management or requirements-tracking software (such as Jira or Trello) and relevant certifications (like CBAP or PMI-PBA) are typically required. Outstanding communication, problem-solving, and self-motivation are essential soft skills for collaborating with stakeholders and managing projects remotely. These competencies ensure the effective translation of business needs into technical solutions, driving successful project outcomes in a remote environment.
How does a remote BSA typically collaborate with cross-functional teams in a virtual environment?
A Remote BSA often works closely with stakeholders from IT, business units, and project management through video calls, collaborative documentation platforms, and project management tools. Effective communication and proactive scheduling of virtual meetings are essential to ensure requirements are clearly understood and delivered. Remote BSAs are expected to be self-motivated, organized, and adept at using digital tools to facilitate workshops, gather requirements, and resolve issues. Building strong relationships remotely is key to ensuring successful project outcomes.
What is the difference between Remote Bsa vs Remote Business Analyst?
| Aspect | Remote Bsa | Remote Business Analyst |
|---|---|---|
| Certifications | CBAP, CCBA, PMI-PBA | CBAP, CCBA, PMI-PBA |
| Work Environment | Remote, collaborative teams, project-based | Remote, data-driven, stakeholder communication |
| Industry Usage | IT, finance, healthcare, various sectors | IT, finance, healthcare, various sectors |
| Common Search/Comparison | Yes | Yes |
Remote Bsa and Remote Business Analyst roles share similar certifications, work environments, and industry usage. Both positions focus on analyzing business needs, improving processes, and working remotely with cross-functional teams. The main difference lies in terminology; 'Bsa' is often used interchangeably with 'Business Analyst,' but some organizations may differentiate based on specific responsibilities or focus areas. Overall, they are closely related roles with overlapping skills and industry applications.
What are the most commonly searched types of Bsa jobs in Tennessee?
The most popular types of Bsa jobs in Tennessee are:
What are popular job titles related to Remote Bsa jobs in Tennessee?
For Remote Bsa jobs in Tennessee, the most frequently searched job titles are:
What job categories do people searching Remote Bsa jobs in Tennessee look for?
The top searched job categories for Remote Bsa jobs in Tennessee are:
What cities in Tennessee are hiring for Remote Bsa jobs?
Cities in Tennessee with the most Remote Bsa job openings:
Senior Analyst, Edits | Payment Integrity (Remote)
Knoxville, TN • On-site, Remote
CGI Inc.
Full-time
Retirement, PTO
Re-posted 20 days ago
Key responsibilities
Identify high-impact edit opportunities using claim data analysis and translate policies into actionable logic.
Design, validate, and implement edits, including creating rule specifications and conducting user acceptance testing.
Monitor edit performance, refine edits based on results, and maintain an inventory of active and obsolete rules.
CGI rating
7.1
Based on 19 frontline employees who took The Breakroom Quiz
Job description
Find similar career opportunities
Senior Analyst, Edits | Payment Integrity (Remote)
Category: Analytics and Emerging Digital Technologies
Main location: United States, Tennessee, Knoxville
Alternate Location(s): United States, Georgia, Atlanta
United States, North Carolina, Charlotte
United States, Virginia, Fairfax
United States, Texas, Dallas
United States, Texas, Houston
Position ID:J0126-0518
Employment Type: Full Time
Position Description:
CGI is seeking a results-oriented Senior Analyst to join our growing Edits team. In this pivotal role, you will be responsible for expansively growing CGI's edits library and driving measurable value by identifying and preventing improper payments.
As a Senior Analyst, you will manage the full lifecycle of edit development-from initial opportunity identification to rules design, clinical validation, and deployment. You will serve as a subject matter expert, blending deep coding domain expertise with advanced analytics to ensure payment accuracy and integrity across the healthcare landscape.
Your future duties and responsibilities:
1. Edit Development & Implementation
Identify Opportunities: Use claim data analysis to pinpoint high-impact edit opportunities.
Translate Policy: Convert medical policy, CMS rules, and coding guidance into actionable logic.
Technical Design: Create detailed rule specifications, including conditions, exclusions, thresholds, and flags.
Validation: Design validation datasets and lead rigorous pre-deployment user acceptance testing (UAT).
2. Monitoring & Optimization
Performance Tracking: Monitor yield, false positives, ROI, and provider abrasion.
Continuous Improvement: Refine edits based on real-world results, coding updates, and provider behavior.
Lifecycle Management: Maintain a documented inventory of active edits and retire obsolete or low-value rules.
3. Clinical & Coding Alignment
Validation: Partner with Medical Directors and internal auditors (RNs/Coders) to ensure clinical appropriateness.
Compliance: Ensure all edits strictly comply with CMS coding policies, NCCI, and LCD/NCD rules.
4. Cross-Functional Collaboration
Stakeholder Engagement: Partner with SIU, claims operations, and policy teams to align on strategy.
Communication: Present edit design rationale and performance dashboards to leadership.
Required qualifications to be successful in this role:
Certifications (Must-Have): Active coding certification (CCS or CPC) with deep clinical coding expertise.
Professional Experience: 5+ years in payment integrity, claims analytics, medical policy, or coding.
Technical Knowledge: Deep expertise in CPT/HCPCS, ICD-10, DRG, APC/OPPS, and NCCI bundling policies.
Domain Expertise: Proven experience in prepay editing or post-pay audit logic.
Education: Bachelor's degree in Business, Healthcare, Data Analytics, Public Health, or a related field (or equivalent experience).
Preferred Skills
Technical Tools: Proficiency in SQL and experience with claims rules platforms (e.g., Optum/CES, Cotiviti, McKesson).
Clinical Background: Current RN licensure.
Other Information:
CGI is required by law in some jurisdictions to include a reasonable estimate of the compensation range for this role. The determination of this range includes various factors not limited to skill set, level, experience, relevant training, and licensure and certifications. To support the ability to reward for merit-based performance, CGI typically does not hire individuals at or near the top of the range for their role. Compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range for this role in the U.S. is $75,000.00 - $100,000.00.
CGI's benefits are offered to eligible professionals on their first day of employment to include:
. Competitive compensation
. Comprehensive insurance options
. Matching contributions through the 401(k) plan and the share purchase plan
. Paid time off for vacation, holidays, and sick time
. Paid parental leave
. Learning opportunities and tuition assistance
. Wellness and Well-being programs
Skills:
What you can expect from us:
Together, as owners, let's turn meaningful insights into action.
Life at CGI is rooted in ownership, teamwork, respect and belonging. Here, you'll reach your full potential because...
You are invited to be an owner from day 1 as we work together to bring our Dream to life. That's why we call ourselves CGI Partners rather than employees. We benefit from our collective success and actively shape our company's strategy and direction.
Your work creates value. You'll develop innovative solutions and build relationships with teammates and clients while accessing global capabilities to scale your ideas, embrace new opportunities, and benefit from expansive industry and technology expertise.
You'll shape your career by joining a company built to grow and last. You'll be supported by leaders who care about your health and well-being and provide you with opportunities to deepen your skills and broaden your horizons.
Come join our team-one of the largest IT and business consulting services firms in the world.
Qualified applicants will receive consideration for employment without regard to their race, ethnicity, ancestry, color, sex, religion, creed, age, national origin, citizenship status, disability, pregnancy, medical condition, military and veteran status, marital status, sexual orientation or perceived sexual orientation, gender, gender identity, and gender expression, familial status or responsibilities, reproductive health decisions, political affiliation, genetic information, height, weight, or any other legally protected status or characteristics to the extent required by applicable federal, state, and/or local laws where we do business.
CGI provides reasonable accommodations to qualified individuals with disabilities. If you need an accommodation to apply for a job in the U.S., please email the CGI U.S. Employment Compliance mailbox at US_Employment_Compliance@cgi.com. You will need to reference the Position ID of the position in which you are interested. Your message will be routed to the appropriate recruiter who will assist you. Please note, this email address is only to be used for those individuals who need an accommodation to apply for a job. Emails for any other reason or those that do not include a Position ID will not be returned.
We make it easy to translate military experience and skills! Click here to be directed to our site that is dedicated to veterans and transitioning service members.
All CGI offers of employment in the U.S. are contingent upon the ability to successfully complete a background investigation. Background investigation components can vary dependent upon specific assignment and/or level of US government security clearance held. Dependent upon role and/or federal government security clearance requirements, and in accordance with applicable laws, some background investigations may include a credit check. CGI will consider for employment qualified applicants with arrests and conviction records in accordance with all local regulations and ordinances.
CGI will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with CGI's legal duty to furnish information.
Have you been referred by a CGI Partner for this position? *
Yes No
CGI Partner's email (@cgi.com)*
First Name
Last Name
I agree to allow CGI to contact the CGI Partner who referred me to obtain additional information about my application and confirm my referral.*
* This field is required.
CGI is an Equal Opportunity Employer, to include disability and protected veteran status; we are committed to compliance with U.S. laws and regulations. Click here to access an overview of our U.S. Equal Employment Opportunity and Anti-Harassment Policy.
Applicants have rights under Federal Employment Laws:
CGI provides reasonable accommodations to qualified individuals with disabilities. If you need an accommodation to apply for a job in the U.S., please email the CGI U.S. Employment Compliance mailbox at US_Employment_Compliance@cgi.com. You will need to reference the Position ID of the position in which you are interested. Your message will be routed to the appropriate recruiter who will assist you. Please note, this email address is only to be used for those individuals who need an accommodation to apply for a job. Emails for any other reason or those that do not include a Position ID will not be returned.
We make it easy to translate military experience and skills! Click here to be directed to our site that is dedicated to veterans and transitioning service members.
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
Senior Analyst, Edits | Payment Integrity (Remote)
Category: Analytics and Emerging Digital Technologies
Main location: United States, Tennessee, Knoxville
Alternate Location(s): United States, Georgia, Atlanta
United States, North Carolina, Charlotte
United States, Virginia, Fairfax
United States, Texas, Dallas
United States, Texas, Houston
Position ID:J0126-0518
Employment Type: Full Time
Position Description:
CGI is seeking a results-oriented Senior Analyst to join our growing Edits team. In this pivotal role, you will be responsible for expansively growing CGI's edits library and driving measurable value by identifying and preventing improper payments.
As a Senior Analyst, you will manage the full lifecycle of edit development-from initial opportunity identification to rules design, clinical validation, and deployment. You will serve as a subject matter expert, blending deep coding domain expertise with advanced analytics to ensure payment accuracy and integrity across the healthcare landscape.
Your future duties and responsibilities:
1. Edit Development & Implementation
Identify Opportunities: Use claim data analysis to pinpoint high-impact edit opportunities.
Translate Policy: Convert medical policy, CMS rules, and coding guidance into actionable logic.
Technical Design: Create detailed rule specifications, including conditions, exclusions, thresholds, and flags.
Validation: Design validation datasets and lead rigorous pre-deployment user acceptance testing (UAT).
2. Monitoring & Optimization
Performance Tracking: Monitor yield, false positives, ROI, and provider abrasion.
Continuous Improvement: Refine edits based on real-world results, coding updates, and provider behavior.
Lifecycle Management: Maintain a documented inventory of active edits and retire obsolete or low-value rules.
3. Clinical & Coding Alignment
Validation: Partner with Medical Directors and internal auditors (RNs/Coders) to ensure clinical appropriateness.
Compliance: Ensure all edits strictly comply with CMS coding policies, NCCI, and LCD/NCD rules.
4. Cross-Functional Collaboration
Stakeholder Engagement: Partner with SIU, claims operations, and policy teams to align on strategy.
Communication: Present edit design rationale and performance dashboards to leadership.
Required qualifications to be successful in this role:
Certifications (Must-Have): Active coding certification (CCS or CPC) with deep clinical coding expertise.
Professional Experience: 5+ years in payment integrity, claims analytics, medical policy, or coding.
Technical Knowledge: Deep expertise in CPT/HCPCS, ICD-10, DRG, APC/OPPS, and NCCI bundling policies.
Domain Expertise: Proven experience in prepay editing or post-pay audit logic.
Education: Bachelor's degree in Business, Healthcare, Data Analytics, Public Health, or a related field (or equivalent experience).
Preferred Skills
Technical Tools: Proficiency in SQL and experience with claims rules platforms (e.g., Optum/CES, Cotiviti, McKesson).
Clinical Background: Current RN licensure.
Other Information:
CGI is required by law in some jurisdictions to include a reasonable estimate of the compensation range for this role. The determination of this range includes various factors not limited to skill set, level, experience, relevant training, and licensure and certifications. To support the ability to reward for merit-based performance, CGI typically does not hire individuals at or near the top of the range for their role. Compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range for this role in the U.S. is $75,000.00 - $100,000.00.
CGI's benefits are offered to eligible professionals on their first day of employment to include:
. Competitive compensation
. Comprehensive insurance options
. Matching contributions through the 401(k) plan and the share purchase plan
. Paid time off for vacation, holidays, and sick time
. Paid parental leave
. Learning opportunities and tuition assistance
. Wellness and Well-being programs
Skills:
- Analytical Thinking
- Regulatory project management
What you can expect from us:
Together, as owners, let's turn meaningful insights into action.
Life at CGI is rooted in ownership, teamwork, respect and belonging. Here, you'll reach your full potential because...
You are invited to be an owner from day 1 as we work together to bring our Dream to life. That's why we call ourselves CGI Partners rather than employees. We benefit from our collective success and actively shape our company's strategy and direction.
Your work creates value. You'll develop innovative solutions and build relationships with teammates and clients while accessing global capabilities to scale your ideas, embrace new opportunities, and benefit from expansive industry and technology expertise.
You'll shape your career by joining a company built to grow and last. You'll be supported by leaders who care about your health and well-being and provide you with opportunities to deepen your skills and broaden your horizons.
Come join our team-one of the largest IT and business consulting services firms in the world.
Qualified applicants will receive consideration for employment without regard to their race, ethnicity, ancestry, color, sex, religion, creed, age, national origin, citizenship status, disability, pregnancy, medical condition, military and veteran status, marital status, sexual orientation or perceived sexual orientation, gender, gender identity, and gender expression, familial status or responsibilities, reproductive health decisions, political affiliation, genetic information, height, weight, or any other legally protected status or characteristics to the extent required by applicable federal, state, and/or local laws where we do business.
CGI provides reasonable accommodations to qualified individuals with disabilities. If you need an accommodation to apply for a job in the U.S., please email the CGI U.S. Employment Compliance mailbox at US_Employment_Compliance@cgi.com. You will need to reference the Position ID of the position in which you are interested. Your message will be routed to the appropriate recruiter who will assist you. Please note, this email address is only to be used for those individuals who need an accommodation to apply for a job. Emails for any other reason or those that do not include a Position ID will not be returned.
We make it easy to translate military experience and skills! Click here to be directed to our site that is dedicated to veterans and transitioning service members.
All CGI offers of employment in the U.S. are contingent upon the ability to successfully complete a background investigation. Background investigation components can vary dependent upon specific assignment and/or level of US government security clearance held. Dependent upon role and/or federal government security clearance requirements, and in accordance with applicable laws, some background investigations may include a credit check. CGI will consider for employment qualified applicants with arrests and conviction records in accordance with all local regulations and ordinances.
CGI will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with CGI's legal duty to furnish information.
Have you been referred by a CGI Partner for this position? *
Yes No
CGI Partner's email (@cgi.com)*
First Name
Last Name
I agree to allow CGI to contact the CGI Partner who referred me to obtain additional information about my application and confirm my referral.*
* This field is required.
CGI is an Equal Opportunity Employer, to include disability and protected veteran status; we are committed to compliance with U.S. laws and regulations. Click here to access an overview of our U.S. Equal Employment Opportunity and Anti-Harassment Policy.
Applicants have rights under Federal Employment Laws:
- EPPA
- FMLA
- Know Your Rights: Workplace Discrimination is Illegal
- Pay Transparency Statement Policy
CGI provides reasonable accommodations to qualified individuals with disabilities. If you need an accommodation to apply for a job in the U.S., please email the CGI U.S. Employment Compliance mailbox at US_Employment_Compliance@cgi.com. You will need to reference the Position ID of the position in which you are interested. Your message will be routed to the appropriate recruiter who will assist you. Please note, this email address is only to be used for those individuals who need an accommodation to apply for a job. Emails for any other reason or those that do not include a Position ID will not be returned.
We make it easy to translate military experience and skills! Click here to be directed to our site that is dedicated to veterans and transitioning service members.
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.