Senior Healthcare Business Analyst / Behavioral Health SME

Senior Healthcare Business Analyst / Behavioral Health SME

Location: USA Remote



Employment Type: Full-Time / Contract



Visa Requirement: Visa Independent Candidates Only Job Overview

We are seeking a highly experienced Senior Healthcare Business Analyst / Behavioral Health SME with strong expertise in Healthcare Payer operations and Behavioral Health . The ideal candidate will have deep knowledge of Behavioral Health processes, payer operations, healthcare regulations, business analysis, and healthcare technology platforms.

The candidate should be able to effectively bridge business and technology teams and drive requirements, process improvements, system solutions, and transformation initiatives.

Required Qualifications

• 10+ years of experience in Healthcare Payer environments.

• 5+ years of hands-on experience in Behavioral Health , including Mental Health and Substance Use Disorders (SUD).

• Strong understanding of the end-to-end healthcare payer lifecycle, including:

  • Eligibility & Enrollment

  • Benefits Configuration

  • Claims Processing & Adjudication

  • Prior Authorization

  • Care & Case Management

  • Provider Management

  • Appeals & Grievances

  • Payment Integrity

• Strong knowledge of Behavioral Health regulations and compliance requirements, including:

  • MHPAEA (Mental Health Parity and Addiction Equity Act)

  • Medicare & Medicaid Behavioral Health programs

  • HIPAA

  • CMS regulations

  • State-specific healthcare requirements

  • NCQA / URAC standards

Business Analysis Skills

• Requirements gathering and analysis

• Business Requirements Documents (BRD)

• Functional Requirements Documents (FRD)

• User Stories and Acceptance Criteria

• Process Mapping

• Gap Analysis

• Business Process Improvement

• UAT / SIT support

• Defect management

• Stakeholder management

• Business and technical solution discussions

Healthcare Payer Platforms

Experience with one or more of the following platforms is highly preferred:

• Facets

• QNXT

• HealthRules

• GuidingCare

• TruCare

• Similar healthcare payer platforms

Healthcare Transactions & Interoperability

Strong understanding of healthcare transactions and interoperability standards, including:

• 837 Claims

• 835 Electronic Remittance Advice

• 834 Enrollment

• 270/271 Eligibility

• HL7

• FHIR

Technical Skills

• Strong SQL skills

• Data analysis

• Healthcare data mapping

• System integration

• Data validation and reconciliation

• Understanding of healthcare interfaces and integrations

Preferred Experience

• Commercial, Medicare, and Medicaid lines of business

• Behavioral Health Care Management

• Utilization Management

• Value-Based Care programs

• Healthcare payer modernization

• Data transformation initiatives

• AI / Digital Transformation initiatives

• Experience working with cross-functional business, technology, product, and vendor teams

Ideal Candidate

The ideal candidate will combine strong Behavioral Health payer SME expertise with senior-level Business Analysis capabilities and healthcare technology knowledge.

The candidate should have demonstrated experience across:

Behavioral Health + Claims + Eligibility + Benefits + Care Management + Provider Operations + Regulatory Compliance + Payer Technology Platforms

The successful candidate should be comfortable leading strategic business discussions as well as detailed system and solution-design discussions with business and technical stakeholders.

Additional Requirements

• Must be authorized to work in the United States without sponsorship.

• Must be available to work remotely.

• Strong communication and stakeholder management skills.

• Ability to work independently and collaboratively in an Agile environment.

• Candidates should be available for interviews on short notice.