Senior Healthcare Business Analyst / Behavioral Health SME
Lorven Technologies Inc
Hi,
Our client is looking for a Senior Healthcare Business Analyst / Behavioral Health SME at Remote.
Kindly share your updated resume to proceed further.
Position: Senior Healthcare Business Analyst / Behavioral Health SME
Location: Remote
Duration: Long Term
Job Description:
- Bachelor's or Master's degree in Computer Science, Information Systems, Engineering, or a related field; relevant architecture and cloud certifications are a plus.
- Must have 10+ years of Healthcare Payer experience with 5+ years in Behavioral Health (Mental Health & Substance Use Disorders) .
- Good and Strong understanding of the end-to-end payer lifecycle : Eligibility & Enrollment, Benefits Configuration, Claims Processing & Adjudication, Prior Authorization, Care & Case Management
and Provider Management, Appeals & Grievances and Payment Integrity
- Strong Experience with Deep knowledge of Behavioral Health regulations , including: MHPAEA (Mental Health Parity), Medicare & Medicaid BH programs, HIPAA, CMS and State-specific regulatory requirements
and NCQA/URAC standards
- Strong Business Analysis skills including the Requirements gathering, BRD/FRD/User Stories and Process mapping, Gap analysis , UAT/SIT support and Stakeholder management
- Experience with payer platforms such as Facets, QNXT, Health Rules, GuidingCare, TruCare, or similar .
- Good Knowledge of healthcare transactions and interoperability standards: 837, 835, 834, 270/271 and HL7/FHIR
- Strong SQL, data analysis, and system integration understanding.
Vacancy posted 1 day ago
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