Healthcare Business Systems Specialist

4 days ago

Udaipur, Rajasthan, India beBeeCompliance Full time ₹ 80,00,000 - ₹ 1,50,00,000
**Job Title:** Senior Business Analyst with HealthCareAbout the Role:

This is a key position that involves collaborating with various stakeholders to ensure system changes, processes, and documentation remain compliant with healthcare regulations and payer guidelines.

  • Gather, Analyze, and Document Business Requirements: The ideal candidate will have expertise in gathering, analyzing, and documenting business requirements related to HIPAA, CMS, NCQA, and state-specific regulations.
  • Ensure Compliance: This role requires ensuring that system changes, processes, and documentation remain compliant with healthcare regulations and payer guidelines.
  • Liaison with Compliance and Legal Teams: As a liaison with compliance and legal teams during audits or regulatory updates, the successful candidate will play a critical role in ensuring accuracy and timeliness.
  • Benefit Codes & Plan Configuration
    • Analyze and Configure Benefit Codes: The candidate will analyze and configure benefit codes for medical, dental, pharmacy, and specialty products.
    • Support Plan Design, Benefit Mapping, and Validation: They will support plan design, benefit mapping, and validation in healthcare systems (e.g., Facets, QNXT, or other payer platforms).
    • Collaborate with Product and IT Teams: Collaboration with product and IT teams is essential to ensure accurate coding, claims adjudication, and eligibility processing.
  • Collateral & Member Materials
    • Coordinate Development and Validation: The candidate will 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: They will partner with marketing and compliance teams to ensure content accuracy, regulatory alignment, and timely delivery.
    • Track Versioning and Approvals: The candidate will track versioning and approvals of collateral to maintain consistency across all distribution channels.

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