Business Analyst, Scope Operations

Business Analyst, Scope Operations

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference working in everything from scrubs to jeans.

Are we growing? Absolutely and Globally. In 2021 we grew our teams by almost 50% and continue to grow even more in 2022. Are we recognized as a company you are supported by for your career and growth, and a great place to work? Definitely. Evolent Health International (Pune, India) has been certified as “Great Places to Work” in 2021. In 2020 and 2021 Evolent in the U.S. was both named Best Company for Women to Advance list by Parity.org and earned a perfect score on the Human Rights Campaign (HRC) Foundation’s Corporate Equality Index (CEI). This index is the nation's foremost benchmarking survey and report measuring corporate policies and practices related to LGBTQ+ workplace equality.

We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

What You’ll Be Doing:

Business Analyst, Scope Operations

The Business Analyst, Scope Operations supports accurate, timely maintenance of clinical and financial scope data across specialty utilization management programs. This role applies regulatory code changes, updates implementation code sets and scope data tables, and performs QA to keep scope information complete, accurate, and aligned to operations.

What You’ll Be Doing:

• Monitor and apply regulatory code changes to the Scope Operations database and supporting tables, including CMS, AMA, FDA, HCPCS, CPT, and ICD-10 updates.
• Enter approved implementation code sets into scope tables based on client, market, line of business, specialty, and product requirements.
• Add, update, retire, or correct code-level records based on approved scope decisions and implementation timelines.
• Perform QA reviews to confirm scope database updates align with source files, regulatory updates, implementation requirements, and operational expectations.
• Research and resolve data discrepancies across scope tables, reports, and downstream operational outputs; escalate issues as needed.
• Document completed updates, QA findings, issue resolution steps, assumptions, and exceptions.
• Partner with Scope Operations, Implementation, Product, Clinical Operations, Analytics, and other teams to support accurate scope configuration and maintenance.
• Support data hygiene, audits, and maintenance routines that improve consistency, traceability, and confidence in scope data.

The Experience You Need (Required):

• Bachelor’s degree or equivalent experience in healthcare operations, business analysis, data management, informatics, or a related field.
• 2+ years of experience with healthcare data, operational data tables, code sets, business rules, or implementation support.
• Strong attention to detail and ability to perform accurate, repeatable data entry and QA.
• Working knowledge of healthcare coding concepts such as HCPCS, CPT, ICD-10, NDC, or related medical management code sets.
• Experience using Microsoft Excel to review, compare, validate, and organize code-level data.
• Ability to follow procedures, identify exceptions, and raise questions when rules or requirements are unclear.
• Strong written and verbal communication skills, including clear documentation of findings, updates, and issues.
• Ability to manage multiple priorities, meet deadlines, and work independently in a fast-paced environment.

Preferred Qualifications:

• Experience with SQL, Microsoft Access, database tables, or reporting tools used to validate healthcare data.
• Experience supporting utilization management, specialty operations, claims, provider, eligibility, or health plan implementation.
• Familiarity with regulatory update cycles and the operational impact of CMS, AMA, FDA, and state code changes.
• Experience with data analysis, reconciliation, and data hygiene across multiple systems or data sources.
• Familiarity with JIRA and Confluence for issue tracking and project management.

Key Competencies:

• Detail-oriented and quality-focused, with strong ownership of data accuracy and operational follow-through.
• Able to translate approved scope rules and code set changes into accurate operational data updates.
• Analytical and organized, with the ability to identify insights, resolve ambiguity, and improve consistency.
• Collaborative and proactive in communicating risks, blockers, data issues, and client-ready updates.

To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. All candidates must complete a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration.

Mandatory Requirements:

Employees must have a high-speed broadband internet connection with a minimum speed of 50 Mbps and the ability to set up a wired connection to their home network to ensure effective remote work. These requirements may be updated as needed by the business.

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Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.