
Healthcare Domain Specialist
4 days ago
We are seeking a highly skilled Senior Business Analyst to join our team. As a Senior Business Analyst, you will play a critical role in ensuring that our healthcare business operations remain compliant with regulatory requirements and industry best practices.
About the Role:
This is an exciting opportunity for a seasoned Business Analyst to leverage their expertise in healthcare domain knowledge, system changes, and compliance to drive business growth and improve operational efficiency. The ideal candidate will have a strong background in analyzing and documenting business requirements, as well as experience in collaborating with cross-functional teams to ensure successful project delivery.
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.
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