Senior Healthcare Business Analyst / Behavioral Health SME

Lorven Technologies Inc

Minnesota

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.

Apply

Vacancy posted 1 day ago

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