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3 days ago
- The ideal candidate will possess a deep understanding of healthcare regulations, including HIPAA, CMS, NCQA, and state-specific laws. They will be responsible for gathering, analyzing, and documenting business requirements to ensure system changes, processes, and documentation remain compliant.
The Business Analyst will serve as a liaison between compliance and legal teams during audits or regulatory updates. This individual must have strong analytical skills and the ability to communicate complex information effectively.
Key Responsibilities:- Benefit Codes & Plan Configuration
- Support plan design, benefit mapping, and validation in healthcare systems (e.g., Facets, QNXT).
- Collaborate with product and IT teams to ensure accurate coding, claims adjudication, and eligibility processing.
- Develop and validate member-facing collateral such as Explanation of Benefits (EOBs), Summary of Benefits and Coverage (SBCs), provider directories, and plan brochures.
- Proven experience in healthcare analytics and compliance.
- Strong communication and interpersonal skills.
- Ability to work in a fast-paced environment and adapt to changing priorities.
- Knowledge of healthcare regulations and industry standards.
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