BA with HC Claims Exp

Business Analyst (BA)

We're looking for a Business Analyst (BA) with significant experience in healthcare claims processing to join our team. The ideal candidate will be a critical link between our business operations and technical teams, translating business needs into technical requirements to improve and optimize our claims systems. This role requires a deep understanding of the healthcare claims lifecycle, including adjudication, billing, and payer-provider interactions.

Key Responsibilities

• Requirements Gathering & Analysis: Work closely with stakeholders to elicit, document, and analyze business requirements for claims processing projects. Translate these business needs into clear, actionable functional and non-functional requirements.
• System & Process Improvement: Identify and recommend improvements to existing claims systems and workflows to enhance efficiency, accuracy, and compliance. This includes analyzing data to uncover trends and potential issues.
• Stakeholder Collaboration: Serve as a liaison between business users, IT developers, and quality assurance teams throughout the project lifecycle. Facilitate meetings and workshops to ensure alignment and clear communication.
• Documentation & Reporting: Create and maintain detailed documentation, including business requirement documents (BRDs), use cases, process flows, and user stories. Develop reports and dashboards to track project progress and key performance indicators (KPIs).
• Testing & Validation: Support the testing phase by reviewing test plans and test cases to ensure they align with the original requirements. Assist in user acceptance testing (UAT) to validate that solutions meet business needs.

Qualifications

• Experience: A minimum of 8 years of experience as a Business Analyst, with at least 4 years of direct experience in the healthcare claims domain.
• Knowledge: Strong understanding of the end-to-end claims lifecycle, including concepts like adjudication, EDI transactions (e.g., 837, 835), coding (e.g., CPT, ICD-10), and compliance standards (e.g., HIPAA).
• Skills:
• Excellent analytical and problem-solving abilities.
• Proficiency in business analysis tools (e.g., JIRA, Confluence, Visio).
• Exceptional communication and interpersonal skills.
• Ability to manage multiple projects and priorities in a fast-paced environment.
• Education: Bachelors degree in Business, Health Informatics, or a related field. Relevant certifications (e.g., CBAP) are a plus.