Senior Business Compliance Specialist

2 weeks ago


Ellore, Andhra Pradesh, India beBeeHealthcare Full time ₹ 1,50,00,000 - ₹ 2,00,00,000
Job Title: Senior Business Analyst with HealthCare

Gather, analyze, and document business requirements related to HIPAA, CMS, NCQA, and state-specific regulations. Ensure system changes, processes, and documentation remain compliant with healthcare regulations and payer guidelines.

About this Role
  • This is a senior-level position that requires expertise in healthcare regulations and compliance.
  • The successful candidate will have experience in analyzing and documenting business requirements, as well as ensuring system changes are compliant with regulations.

Key Responsibilities:

  • Gather, analyze, and document business requirements related to HIPAA, CMS, NCQA, and state-specific regulations.
  • Ensure system changes, processes, and documentation remain compliant with healthcare regulations and payer guidelines.
  • Act as liaison with compliance and legal teams during audits or regulatory updates.
  • Analyze and configure benefit codes for medical, dental, pharmacy, and specialty products.
  • Support plan design, benefit mapping, and validation in healthcare systems (e.g., Facets, QNXT, or other payer platforms).
  • Collaborate with product and IT teams to ensure accurate coding, claims adjudication, and eligibility processing.
  • Coordinate development and validation of member-facing collateral such as Explanation of Benefits (EOBs), Summary of Benefits and Coverage (SBCs), provider directories, and plan brochures.
  • Partner with marketing and compliance teams to ensure content accuracy, regulatory alignment, and timely delivery.
  • Track versioning and approvals of collateral to maintain consistency across all distribution channels.
Requirements:
  • Bachelor's degree in Business Administration, Healthcare Administration, or a related field.
  • At least 5 years of experience in healthcare compliance and regulation.
  • Proven track record of ensuring system changes are compliant with regulations.
  • Strong analytical and communication skills.
  • Ability to work effectively in a team environment.


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