
Senior Business Analyst for Healthcare Operations
19 hours ago
Job Summary:
About This Role- This position is responsible for ensuring that our healthcare systems, processes and documentation remain compliant with healthcare regulations and payer guidelines.
Key Responsibilities:
- Gather, analyze and document business requirements related to HIPAA, CMS, NCQA and state-specific regulations.
- E nsure 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.
- Benefits Administration
- 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.
Collateral Development
- 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:
- Prior experience in a similar role within the healthcare industry.
- Strong analytical skills and ability to interpret complex data.
- Excellent communication and interpersonal skills.
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