
Senior Healthcare Operations Specialist
1 day ago
Healthcare Business Analyst Role
As a key member of our organization, you will be responsible for the analysis and documentation of business requirements related to healthcare regulations.
- Gather and Analyze Regulatory Requirements:
The ideal candidate will have experience in gathering, analyzing, and documenting business requirements related to HIPAA, CMS, NCQA, and state-specific regulations.
- Ensure Compliance:
He/She must ensure that system changes, processes, and documentation remain compliant with healthcare regulations and payer guidelines.
- Collaborate with Teams:
As liaison with compliance and legal teams during audits or regulatory updates, he/she will provide support and guidance to ensure accurate coding, claims adjudication, and eligibility processing.
- Benefit Configuration:
Additionally, the selected candidate will analyze and configure benefit codes for medical, dental, pharmacy, and specialty products.
- Plan Design and Validation:
Support plan design, benefit mapping, and validation in healthcare systems, such as Facets, QNXT, or other payer platforms.
- Member Materials:
Coordinate development and validation of member-facing collateral like Explanation of Benefits (EOBs), Summary of Benefits and Coverage (SBCs), provider directories, and plan brochures.
- Collateral Versioning:
Track versioning and approvals of collateral to maintain consistency across all distribution channels.
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