Sr Business Analyst with AI Claude / Healthcare Provider

Role : Sr Business Analyst with AI Claude / Healthcare Provider

Location : Remote

Exp: 10+ years

Job Summary

CitiusTech is seeking an experienced AI-Enabled Provider Business Analyst with strong expertise in Provider Data Management, Credentialing, Provider Enrollment, Provider Directory Management, and Network Operations within the healthcare payer/provider ecosystem.

The ideal candidate will collaborate with business stakeholders, provider operations teams, architects, product owners, and engineering teams to support large-scale provider data management platforms and drive successful delivery of business and technology initiatives. The role requires a strong blend of healthcare provider operations knowledge, business analysis capabilities, data analysis skills, and the ability to leverage AI-enabled tools to accelerate delivery outcomes.

Key Responsibilities

Provider Data Management

• Serve as a Subject Matter Expert (SME) for provider data management processes supporting:
  • Practitioners
  • Provider Groups
  • Facilities
  • Organizational Entities
  • Delegated Entities
  • Affiliated Networks
• Analyze and document end-to-end provider lifecycle workflows, including:
  • Provider onboarding
  • Payer enrollment
  • Credentialing and re-credentialing
  • Provider profile maintenance
  • Network participation
  • Provider termination
• Understand and document provider data structures, business rules, and operational processes, including:
  • Provider Profile Management
  • Provider Directory Management
  • Provider Affiliations
  • Certifications and Specialties
  • Payer Enrollment
  • Provider Hierarchy Management
• Analyze provider master data architecture, including:
  • Provider identity management
  • Provider hierarchies
  • Affiliations and cross-organizational relationships
  • Duplicate resolution
  • Provider record stewardship
• Define, analyze, and validate business rules related to:
  • Provider data creation
  • Data synchronization
  • Reconciliation and enrichment
  • Lifecycle management
• Collaborate with credentialing, provider operations, enrollment, and network management teams to support:
  • Primary Source Verification (PSV)
  • Credential verification
  • Provider onboarding
  • Lifecycle management activities
• Identify opportunities to improve provider data quality, stewardship, completeness, timeliness, and operational efficiency.
• Define provider master data requirements across:
  • Practitioners
  • Facilities
  • Organizations
  • Provider Groups
• Support process improvement initiatives focused on:
  • Provider data governance
  • Data quality
  • Compliance
  • Operational effectiveness
• Document exception handling and escalation workflows related to credentialing and provider management processes.

Provider Data Platform Analysis & Integration

• Analyze provider data flows, integration touchpoints, and system dependencies across:
  • Credentialing platforms
  • Enrollment systems
  • Provider directories
  • Network management platforms
  • Operational systems
• Document provider data mapping requirements and validate business rules supporting enterprise-wide data exchanges.
• Assess business impacts related to:
  • Provider data model changes
  • Integration enhancements
  • Provider relationship updates
• Partner with architects and engineering teams to validate:
  • Provider data definitions
  • Data transformations
  • Reconciliation processes
  • Operational readiness
• Support API-driven provider data exchange initiatives and modern interoperability implementations.

AI-Enabled Business Analysis

• Leverage AI tools such as Claude and other approved AI accelerators to improve:
  • Requirements gathering
  • Business analysis
  • Process documentation
  • Business rule validation
  • Agile delivery activities
• Use AI-enabled frameworks to generate:
  • User stories
  • Acceptance criteria
  • Functional requirements
  • Business rules
  • Process documentation
• Facilitate:
  • Backlog refinement
  • Priority management
  • Epic decomposition
  • Sprint planning
  • Dependency tracking
  • Release readiness
• Analyze existing business processes, provider data models, integration patterns, and application artifacts to accelerate solution onboarding and delivery.

Data Analysis, Metrics & Reporting

• Perform detailed analysis of:
  • Provider data models
  • Provider hierarchies
  • Entity relationships
  • Affiliation structures
  • Data quality patterns
  • Integration flows
• Investigate and recommend solutions for:
  • Duplicate provider records
  • Enrollment discrepancies
  • Credentialing exceptions
  • Data integrity issues
• Define and monitor business KPIs and operational metrics related to:
  • Provider onboarding
  • Credentialing
  • Enrollment
  • Network management
• Communicate business impacts, delivery outcomes, operational risks, and recommendations to stakeholders.

Collaboration & Stakeholder Management

• Work closely with product owners, architects, engineering teams, and business stakeholders to ensure alignment between business requirements and technical solutions.
• Support solution design discussions and evaluate business impacts of:
  • Data model changes
  • Integration implementations
  • Platform modernization initiatives
• Act as the liaison between business and technology teams throughout the SDLC.

Required Qualifications

• Bachelor's degree in Healthcare Administration, Information Systems, Computer Science, Business Administration, or related field.
• 8+ years of Business Analysis experience in Healthcare.
• Strong experience in:
  • Provider Data Management
  • Provider Credentialing
  • Provider Enrollment
  • Provider Directory Management
  • Network Operations
• Deep understanding of:
  • Provider lifecycle management
  • Provider master data management
  • Provider affiliations and hierarchies
  • Data governance and stewardship
• Experience working in Agile/Scrum environments.
• Proven expertise in:
  • Requirement gathering
  • Business process modeling
  • User story creation
  • Acceptance criteria definition
  • Stakeholder management
• Strong analytical and problem-solving skills.

Preferred Qualifications

• Experience with Provider Data Management platforms and Master Data Management (MDM) solutions.
• Exposure to healthcare interoperability standards and API-based integrations.
• Experience supporting enterprise provider directory and network management solutions.
• Familiarity with AI-assisted business analysis tools and delivery frameworks.
• Certification such as:
  • CBAP
  • CCBA
  • PMI-PBA
  • Certified Scrum Product Owner (CSPO)
  • SAFe Business Analyst

Key Skills

Domain Skills

• Provider Data Management
• Provider Credentialing
• Provider Enrollment
• Provider Directory Management
• Provider Network Operations
• Provider Lifecycle Management
• Primary Source Verification (PSV)
• Healthcare Payer Operations

Business Analysis Skills

• Requirements Gathering
• User Stories & Acceptance Criteria
• Process Modeling
• Gap Analysis
• Impact Analysis
• Data Mapping
• Business Rule Definition
• Stakeholder Management

Technical Skills

• Data Analysis
• API Integrations
• Provider Data Models
• Master Data Management (MDM)
• Data Governance
• Data Quality Management
• Agile/Scrum

AI & Productivity Tools

• Claude
• AI-Assisted Business Analysis Tools
• AI-Based Documentation and Requirement Generation

Educational Qualifications: -

Engineering Degree BE/ME/BTech/MTech/BSc/MSc.

Technical certification in multiple technologies is desirable.