Healthcare Business System Analyst
3 days ago
Key Responsibilities
- Gather, document, and analyze business requirements specific to healthcare payor processes (claims, eligibility, benefits, enrollment, billing, provider network management, etc.).
- Translate business needs into detailed functional and technical requirements.
- Collaborate with stakeholders, product managers, and IT teams to design and enhance payor-related systems.
- Perform gap analysis, workflow mapping, and process improvements to optimize payor operations.
- Support system configuration, integration, testing (SIT/UAT), and deployment activities.
- Ensure compliance with industry standards and regulations (HIPAA, ICD, CPT, HL7, FHIR, X12 EDI transactions).
- Act as a liaison between business users and technical teams to ensure solutions meet requirements.
- Provide ongoing support, issue resolution, and system enhancements for payor systems.
- Prepare reports, dashboards, and documentation to support decision-making.
Mandatory Skills
- Strong domain knowledge in Healthcare Payor (Claims Adjudication, Enrollment, Billing, Eligibility, Provider, Benefits, Utilization Management).
- Hands-on experience with healthcare standards and compliance (HIPAA, X12 EDI transactions 270/271, 276/277, 837/835, etc.).
- Proficiency in requirement gathering, documentation, and system analysis.
- Strong knowledge of SDLC, Agile/Scrum methodologies.
- Excellent analytical, problem-solving, and communication skills.
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