Sr Business Analyst

Ampcus Inc. is a certified global provider of a broad range of Technology and Business consulting services. We are in search of a highly motivated candidate to join our talented Team.

Location

Eden Prairie, MN (Local to MN)

Detailed Job Description

• Ambulatory Optum is seeking a highly experienced healthcare business analytics and methodology subject matter expert to support the design, validation, and evolution of analytic solutions for hospitals, ambulatory settings, and cross-continuum care.
• This role is focused on translating complex healthcare quality, utilization, patient safety, and regulatory measure concepts into market-ready analytic methodologies, documentation, and product guidance.
• The ideal candidate will bring deep expertise in CMS quality programs, healthcare data structures, benchmarking logic, and measure feasibility across claims, billing, encounter, and EHR/EMR-based data environments.
• As a key member of a cross-functional team that includes product managers, analysts, engineers, clinical experts, and implementation partners, you will help define methodology, review measure specifications, validate source data and attribution logic, and ensure alignment between regulatory intent, analytic design, and product implementation.
• You will be expected to provide guidance on ambulatory and cross-continuum use cases, support beta implementations, evaluate data limitations and edge cases, and contribute to clear, defensible documentation that supports both internal teams and external clients.
• Success in this role requires strong healthcare (especially Provider) domain knowledge, analytical precision, and the ability to translate business and clinical requirements into scalable analytic logic.

Basic Qualifications

• Undergraduate Degree in business management, information systems, or healthcare-related field or 5 years' work experience in IT or Healthcare industry.
• 3 years of demonstrated experience as a Business Analyst in support of software development.
• 3 years healthcare claims data content experience. Must be familiar with claim structure data components and relationships.

Required Qualifications

• Methodology & Healthcare Analytics Expertise (Must have)
• Demonstrated experience in healthcare analytics methodology, including measure definition, attribution logic, exclusions, denominators, and numerators, with the ability to clearly articulate “why” behind methodology decisions.
• Deep expertise in CMS quality programs, including ASCQR, OQR, and HQR (Web-based measures), with the ability to interpret regulatory updates and translate program intent into product methodology and implementation guidance.
• Proven ability to review, validate, and sign off on analytic methodology by comparing documented logic against implemented code, ensuring alignment across specification, help site documentation, and system output.
• Strong understanding of clinical, billing, and patient safety data domains, including claims and encounter level data dependencies used in Crimson AI analytics.
• Strong understanding of industry concepts, including cost of care, quality of care, utilization, value-based care, and health risk, with the ability to apply these concepts in the design and interpretation of performance and outcomes measures.
• Hands-on experience creating and maintaining formal methodology documentation, including: Concept Specifications Map/Dictionary Specifications Versioned methodology updates aligned to governance expectations.
• Demonstrated capability to identify, document, and explain methodology differences, with a strong focus on client trust and defensibility.
• Experience supporting client-specific investigations, including reconciling data discrepancies, validating outputs, and partnering with teams to close gaps before release.
• Experience working with CMS aligned measures, regulatory analytics, or hospital quality programs, especially in environments requiring frequent methodology updates and traceability.
• Ability to work hands-on with SQL or analytic queries to validate methodology outputs and confirm parity between code and documented logic, even when automation is not available.
• Ability to work, query in Azure Databricks, and generate analysis on client files to determine feasibility and quality of the data, identify any deficiencies.
• Working Knowledge about the HL7 - FHIR format, structure, and understanding of related data in JSON/XML format.
• Familiarity with the most used FHIR resources. Mapping of custom data models to FHIR resources Mapping of custom datasets to industry standard sets, specifically as accepted by FHIR resources.
• Experience with statistical concepts, including measure construction, risk adjustment principles, stratification, and interpretation of provider level and operational metrics to support analytic and methodological decisions.
• Experience reviewing measure definitions against medical coding updates, including identifying and incorporating newly added changes to methodology accuracy and Maintenance.
• Ability to define benchmarking approaches for quality and utilization measures, including selection of the most appropriate benchmark datasets.
• Ability to explain methodology decisions to non-technical stakeholders Comfort presenting or defending methodology in cross-team or leadership forums, particularly when addressing data or trust concerns from external clients.
• Ability to provide guidance on incorporating eCQMs and other emerging measure types into existing quality and utilization of analytics frameworks.

Preferred Qualifications

• Nice to Have: Ambulatory & Patient Safety Data Expertise.
• Ability to serve as an ambulatory/outpatient data SME during implementations by validating use cases, resolving edge cases, and ensuring methodology fit across care settings and user workflows.
• Demonstrated expertise in ambulatory and post-acute care (Client) data domains, with hands-on experience interpreting EHR/EMR derived data.
• Strong understanding of how patient workflows across various care settings (Inpatient, Outpatient, Post Acute care) and patient safety events are captured within EHR/EMR systems.
• Experience working with ambulatory data sets, including but not limited to: Office / clinic visits Hospital Outpatient Departments (HOPD) Ambulatory Surgery Centers (ASC) Post-acute settings such as SNF, home health, or other outpatient adjacent settings.
• Ability to assess data availability, data provenance, and feasibility for ambulatory and patient safety-oriented measures.
• Proven capability to recommend appropriate data domains (clinical, encounter, procedure, diagnosis, medication, etc.) based on measure of intent and use case.
• Experience evaluating measure feasibility and limitations across heterogeneous ambulatory data sources.
• Familiarity with ambulatory quality, utilization, and patient safety concepts as represented in structured EHR/EMR data.
• Ability to collaborate with analytics and product teams to translate clinical intent into feasible ambulatory measures.

Clinical Expertise

• Clinical background (e.g., physician, advanced practitioner, nurse leader) or senior quality/clinical analytics professional.
• Demonstrated experience with clinical quality metrics, performance indicators, or outcomes measures.
• Strong understanding of provider level performance measurement in hospital or ambulatory settings.
• Familiarity with interpreting risk adjusted or case mix–adjusted metrics.
• Ability to evaluate measures for face validity, fairness, and clinical credibility.
• Experience working with multidisciplinary teams (clinical, quality, analytics, operations).