Healthcare Regulatory Expert

6 hours ago

Kota, Rajasthan, India beBeeRegulatory Full time ₹ 8,00,000 - ₹ 15,00,000
Job Title: Senior Business Analyst with HealthCare

The role of a Senior Business Analyst in the healthcare domain involves working closely with compliance and legal teams to ensure system changes, processes, and documentation remain compliant with healthcare regulations and payer guidelines. This includes analyzing and configuring benefit codes for medical, dental, pharmacy, and specialty products, as well as collaborating with product and IT teams to ensure accurate coding, claims adjudication, and eligibility processing.

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 Management, or a related field.
  • Minimum 5 years of experience in healthcare analytics or business analysis.
  • Strong knowledge of healthcare regulations, including HIPAA, CMS, NCQA, and state-specific regulations.
  • Excellent analytical, problem-solving, and communication skills.
  • Ability to work effectively in a team environment and manage multiple priorities.

Benefits:

  • A competitive salary and benefits package.
  • The opportunity to work on complex healthcare projects and make a meaningful impact.
  • A collaborative and dynamic work environment.

About Us:

We are a leading healthcare organization dedicated to providing high-quality patient care and innovative solutions. We are committed to fostering a culture of excellence, diversity, and inclusion. If you are a motivated and experienced professional looking for a new challenge, we encourage you to apply.

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