
Senior Healthcare Business Strategist
1 day ago
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.
Key Responsibilities
Benefit Codes & Plan Configuration
- 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
Collaborate 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
A bachelor's degree in a related field and relevant experience working in the healthcare industry are required.
- Knowledge of healthcare regulations, including HIPAA, CMS, and NCQA, is essential.
- Strong analytical and problem-solving skills are necessary.
- Excellent communication and collaboration skills are required.
Benefits
Competitive salary and benefits package.
Opportunities for professional growth and development.
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