Business Analyst-Healthcare Payer

As an experienced Business Analyst with extensive expertise in the Healthcare Payer domain, you will join our team as a Subject Matter Expert (SME). Your role will involve the following responsibilities: - Act as a trusted SME for Healthcare Payer processes, policies, regulations, and industry best practices - Elicit and analyze complex business requirements from cross-functional stakeholders, including payers, providers, and other entities - Define and write functional specifications, process flows, and use cases to guide solution design and delivery - Collaborate with IT, QA, and business teams to align on project scope, objectives, and deliverables - Perform gap analyses to pinpoint areas for process optimization and system enhancements - Participate in workshops and stakeholder meetings to gather insights, validate requirements, and drive alignment - Translate intricate business processes into clear, actionable technical documentation for developers - Provide expert guidance during solution implementation to ensure compliance and alignment with business goals - Support stakeholders through training and change management initiatives Qualifications required for this role include: - Bachelor's degree in Science or a related field - Minimum of 5 years of experience within the Healthcare Payer domain - Deep understanding of payer operations including claims processing, enrolment, member management, provider networks, and benefit administration - Knowledge of Business Process and a good understanding of EDI - Strong understanding of healthcare data formats, standards, and the ability to map them to CMS and state level reporting needs - Knowledge of healthcare regulations and compliance standards (e.g., HIPAA, CMS, ACA) - Expertise with payer systems such as claims management, enrolment platforms, billing, and provider portals - Exceptional communication and stakeholder engagement skills, both written and verbal - Familiarity with Agile and Scrum methodologies - Proficiency with Business Analysis tools and techniques It would be nice to have the following: - Certified Business Analysis Professional (CBAP) - Healthcare-specific certifications such as CHC or CPCO As an experienced Business Analyst with extensive expertise in the Healthcare Payer domain, you will join our team as a Subject Matter Expert (SME). Your role will involve the following responsibilities: - Act as a trusted SME for Healthcare Payer processes, policies, regulations, and industry best practices - Elicit and analyze complex business requirements from cross-functional stakeholders, including payers, providers, and other entities - Define and write functional specifications, process flows, and use cases to guide solution design and delivery - Collaborate with IT, QA, and business teams to align on project scope, objectives, and deliverables - Perform gap analyses to pinpoint areas for process optimization and system enhancements - Participate in workshops and stakeholder meetings to gather insights, validate requirements, and drive alignment - Translate intricate business processes into clear, actionable technical documentation for developers - Provide expert guidance during solution implementation to ensure compliance and alignment with business goals - Support stakeholders through training and change management initiatives Qualifications required for this role include: - Bachelor's degree in Science or a related field - Minimum of 5 years of experience within the Healthcare Payer domain - Deep understanding of payer operations including claims processing, enrolment, member management, provider networks, and benefit administration - Knowledge of Business Process and a good understanding of EDI - Strong understanding of healthcare data formats, standards, and the ability to map them to CMS and state level reporting needs - Knowledge of healthcare regulations and compliance standards (e.g., HIPAA, CMS, ACA) - Expertise with payer systems such as claims management, enrolment platforms, billing, and provider portals - Exceptional communication and stakeholder engagement skills, both written and verbal - Familiarity with Agile and Scrum methodologies - Proficiency with Business Analysis tools and techniques It would be nice to have the following: - Certified Business Analysis Professional (CBAP) - Healthcare-specific certifications such as CHC or CPCO