Business Analyst (Healthcare Payer)
Lorven Technologies Inc
Hi,
Our client is looking for a Business Analyst (Healthcare Payer) in Louisville, Kentucky, below is the detailed requirement.
Job Title: Business Analyst (Healthcare Payer)
Location: Louisville, Kentucky
Job Description:
- Bachelor's degree in Business Administration, Healthcare Administration, Information Systems, or a related field.
- Strong experience in healthcare payer operations and business analysis.
- Deep understanding of healthcare payer functions, including:
- Enrollment and Eligibility
- Claims Processing and Adjudication
- Provider Network and Contract Management
- Utilization Management
- Care Management
- Customer Service Operations
- Payment Integrity
- Appeals and Grievances
- Experience gathering and documenting business and functional requirements.
- Strong analytical, communication, facilitation, and stakeholder management skills.
- Experience working in Agile and Waterfall delivery environments.
Preferred Qualifications
- Experience with Medicare, Medicaid, Commercial, and Dual-Eligible healthcare programs.
- Knowledge of healthcare standards such as FHIR, HL7, EDI X12, HEDIS, STAR Ratings, and CMS regulations.
- Experience supporting payer modernization, digital transformation, data management, analytics, or AI-enabled initiatives.
Vacancy posted 2 days ago
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