AI-Enabled Provider Business Analyst

Job Description:

Role: AI-Enabled Provider Business Analyst

Location: Remote Role

Experience:10+ Years

Position Summary

We are seeking an experienced Provider Business Analyst with deep expertise in Provider Data Management, Credentialing, Provider Enrollment, Provider Directory Management, and Network Operations within the healthcare industry.

The ideal candidate will work closely with business stakeholders, provider operations teams, architects, and engineering teams to support large-scale provider data management platforms and drive successful delivery of business and technology initiatives.

Work Location Requirement: Remote Role

Key Responsibilities

Provider Data Management, Credentialing & Network Operations Domain Expertise

• Act as a subject matter expert for provider data management processes supporting practitioners, provider groups, facilities, organizational entities, delegated entities, and affiliated networks.

• Analyze and document end-to-end provider lifecycle workflows, including provider onboarding, payer enrollment, credentialing, recredentialing, profile maintenance, network participation, and provider termination activities.

• Develop a deep understanding of provider data structures, business rules, provider relationships, and operational processes, including provider profile management, provider directory management, provider affiliations, certifications, specialties, payer enrollment, and provider hierarchy management.

• Analyze provider master data architecture, including provider identity management, provider hierarchies, affiliations, cross-organizational relationships, duplicate resolution, and provider record stewardship processes.

• Define and validate business rules governing provider data creation, synchronization, reconciliation, enrichment, and lifecycle management across upstream and downstream systems.

• Collaborate with credentialing, provider operations, enrollment, and network management teams to define and validate business rules supporting Primary Source Verification (PSV), credential verification, provider onboarding, and provider lifecycle management processes.

• Partner with business stakeholders to identify opportunities to improve provider data quality, accuracy, completeness, stewardship, and timeliness.

• Define and document provider master data requirements across practitioner, facility, organizational, and provider group entities.

• Support business process improvements related to provider data accuracy, completeness, governance, and regulatory compliance.

• Document exception processing and escalation workflows related to provider credentialing activities.

Provider Data Platform Analysis & Integration

• Analyze provider data flows, integration touchpoints, and dependencies across credentialing, enrollment, provider directory, network management, and operational systems.

• Document provider data mapping requirements and validate business rules supporting provider data exchange across enterprise applications.

• Assess business impacts of provider data model changes, integration enhancements, and provider relationship updates.

• Partner with architects and engineering teams to validate provider data definitions, transformations, reconciliation processes, and operational readiness.

• Exposure to API-based provider data exchanges and modern interoperability standards is preferred.

AI-Enabled Business Analysis

• Leverage Claude on a day-to-day basis to accelerate business analysis, requirements gathering, process documentation, business rule validation, and Agile delivery activities.

• Utilize AI-enabled frameworks and accelerators to generate high-quality user stories, acceptance criteria, business rules, process documentation, and functional specifications.

• Support backlog refinement, prioritization, epic decomposition, sprint planning, dependency management, and release readiness activities.

• Rapidly analyze existing business processes, provider data models, integration patterns, and application artifacts to accelerate onboarding into active delivery programs.

Data Analysis, Metrics & Reporting

• Perform in-depth analysis of provider data models, entity relationships, provider hierarchies, affiliation structures, integration flows, and data quality patterns.

• Analyze provider data quality issues, duplicate records, enrollment discrepancies, credentialing exceptions, and data integrity challenges, and recommend corrective actions.

• Define and monitor business KPIs, operational metrics, and success criteria for provider onboarding, credentialing, enrollment, and network management workflows.

• Communicate business impacts, operational risks, and delivery outcomes to stakeholders.

Collaboration with Engineering Teams

• Work closely with engineering teams to ensure business requirements align with solution designs.

• Analyze impacts of data model changes and communicate business implications to stakeholders.