
Healthcare Business Results Specialist
5 days ago
Business Analyst – Healthcare Specialist
Deliver business results by leading the analysis and documentation of healthcare-related business requirements.
The ideal candidate will have experience in gathering, analyzing, and documenting business requirements related to HIPAA, CMS, NCQA, and state-specific regulations. You will also ensure that system changes, processes, and documentation remain compliant with healthcare regulations and payer guidelines.
This role requires a strong understanding of healthcare regulatory environments and the ability to analyze and configure benefit codes for medical, dental, pharmacy, and specialty products. Additionally, you will support plan design, benefit mapping, and validation in healthcare systems, as well as collaborate with product and IT teams to ensure accurate coding, claims adjudication, and eligibility processing.
Analyze and optimize business processes to improve efficiency and reduce costs. Coordinate the development and validation of member-facing collateral such as Explanation of Benefits (EOBs), Summary of Benefits and Coverage (SBCs), provider directories, and plan brochures.
You will work closely with compliance and legal teams to ensure alignment with regulatory requirements. This role is ideal for individuals who are passionate about delivering business value through process improvement and regulatory expertise.
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