Senior Business Analyst

4 weeks ago

Chennai, India TESTQ Technologies Limited Full time

Description:We are seeking an experienced Senior Healthcare Business Analyst RCM (Revenue Cycle Management) to lead end-to-end requirements gathering, process analysis, and solution mapping for healthcare and RCM systems.The ideal candidate will possess in-depth knowledge of U.S healthcare workflows, claims processing, payer-provider interactions, and EHR/EMR systems, while maintaining strong familiarity with HIPAA compliance and regulatory requirements.This role bridges the gap between business operations and technology, ensuring that healthcare RCM processes are efficiently digitized, automated, and optimized.You will collaborate closely with stakeholders across business, product, and engineering teams to define system functionalities and deliver process-driven healthcare solutions.What Youll Do:- Act as a subject matter expert (SME) in Revenue Cycle Management (RCM), encompassing claims lifecycle, billing, coding, denial management, and reimbursement workflows.- Gather, document, and analyze business requirements from internal stakeholders, clients, and end users in alignment with RCM processes.- Create detailed process flow diagrams, use cases, and business requirement documents (BRDs) for development and QA teams.- Collaborate with product managers and development teams to design and validate RCM modules including claims adjudication, remittance, and collections.- Work with EHR/EMR system integrations to streamline data exchange and ensure interoperability between clinical and financial systems.- Define business rules and workflows for claims submission, payment posting, and revenue reporting.- Support system configuration, testing, and user acceptance to ensure solution alignment with business needs.- Ensure adherence to HIPAA, HITECH, and other healthcare data privacy standards.- Identify process improvement opportunities to enhance automation, accuracy, and turnaround times in RCM operations.- Act as a liaison between business teams, IT, and clients to resolve issues and ensure clear communication across stakeholders.What You Bring:- Minimum of 10 years of experience as a Business Analyst in the Healthcare and RCM domain.- Deep understanding of end-to-end RCM processes patient registration, charge capture, claims management, payment posting, and AR follow-up.- Hands-on experience with claims formats (837/835) and EHR/EMR integrations.- Strong knowledge of HIPAA compliance, data governance, and healthcare regulatory requirements.- Proven experience in requirement elicitation, gap analysis, functional specification writing, and process documentation.- Familiarity with payer-provider ecosystems, clearinghouses, and RCM platforms.- Ability to conduct UAT (User Acceptance Testing) and assist QA teams in validating functional workflows.- Excellent analytical, problem-solving, and communication skills for client and stakeholder engagement.- Proficiency with tools such as MS Visio, JIRA, Confluence, and other documentation or collaboration platforms.- Bachelors or Masters degree in Healthcare Administration, Life Sciences, Computer Science, or a related discipline.Preferred Skills:- Experience working with EHR systems like Epic, Cerner, or Athenahealth.- Knowledge of automation in RCM processes using AI/ML or workflow engines.- Exposure to value-based care, population health analytics, or payer analytics.- Understanding of FHIR / HL7 standards and data interoperability frameworks (ref:iimjobs.com)

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