Business Analyst (RCM - Healthcare Technology)

Business Analyst

Department: Product Management / Software Development

Reports To: Product Manager

Location: On-Site (preferred), Hybrid, or Remote

Industry: Healthcare Technology, Revenue Cycle Management (RCM)

Position Summary

The Business Analyst serves as the critical link between healthcare operations, revenue cycle management (RCM), and software development teams. This role is responsible for gathering, analyzing, documenting, and validating business requirements related to post-acute care billing workflows, reimbursement processes, claims management, and payer integration solutions.

The ideal candidate possesses strong knowledge of reimbursement methodologies, medical billing operations, and healthcare software development practices. They will collaborate with stakeholders across product management, engineering, quality assurance, implementation, and customer success teams to design and deliver solutions that improve billing accuracy, operational efficiency, regulatory compliance, and financial outcomes for healthcare providers.

Key Responsibilities

Business Analysis & Requirements Management

• Elicit, analyze, document, and manage business, functional, and technical requirements.
• Conduct stakeholder interviews, workflow analysis, and discovery sessions with customers and internal teams.
• Develop detailed user stories, process flows, use cases, business rules, and acceptance criteria.
• Translate complex healthcare billing requirements into actionable specifications for software development teams.
• Identify process improvement opportunities and recommend technology solutions.

Healthcare Revenue Cycle & Billing Expertise

• Analyze workflows related to:
• Claims creation and submission
• Electronic remittance processing (ERA)
• Eligibility verification
• Denial management
• Payment posting
• Accounts receivable management
• Contract and reimbursement management
• Support product enhancements for Medicare, Medicaid, Managed Care, and Commercial Payer billing requirements.
• Monitor regulatory and payer changes affecting reimbursement and billing operations.

Product & Development Collaboration

• Partner with Product Managers to define product roadmaps and feature requirements.
• Work with software developers to clarify requirements throughout the development lifecycle.
• Participate in Agile ceremonies including backlog grooming, sprint planning, reviews, and retrospectives.
• Assist Quality Assurance teams with test scenarios and validation activities.
• Review delivered functionality to ensure alignment with business requirements.

Data Analysis & Reporting

• Analyze billing, claims, and reimbursement data to identify trends and opportunities.
• Create reports, dashboards, and metrics to support product decisions.
• Validate data integrity between healthcare systems and integrated applications.
• Support root cause analysis for production issues and customer-reported defects.

Customer & Stakeholder Engagement

• Serve as a subject matter expert for post-acute care billing workflows.
• Collaborate with customers to understand operational challenges and product enhancement opportunities.
• Support product demonstrations, customer meetings, and implementation discussions.
• Assist training and documentation teams with user-focused materials.

Required Qualifications

Education

• Bachelor's degree in Business Administration, Healthcare Administration, Information Systems, Computer Science, Finance, or a related field.
• Equivalent healthcare technology experience may be considered in lieu of degree requirements.

Experience

• 3+ years of Business Analyst experience in healthcare software, healthcare IT, or revenue cycle management.
• 2+ years of experience supporting medical billing, claims management, or healthcare reimbursement operations.
• Experience working in Agile software development environments.
• Proven experience documenting requirements and translating business needs into software solutions.

Technical Skills

• Requirements gathering and documentation
• Process mapping and workflow analysis
• User story creation and backlog management
• SQL and data analysis preferred
• REST APIs and healthcare system integrations preferred
• Microsoft Office Suite, Azure DevOps, Jira, Confluence, or similar tools

Healthcare Knowledge

Understanding of:

• Medical billing and collections
• Medicare and Medicaid reimbursement methodologies
• US healthcare, including CMS regulations and compliance requirements
• Electronic claims and remittance standards
• Payor requirements

Preferred Qualifications

• Experience with RCM platforms, clearinghouses, EHR/EMR systems, or practice management software.
• Knowledge of healthcare interoperability standards such as HL7, FHIR, X12, and EDI transactions.
• Familiarity with Value-Based Care and alternative payment models.

Core Competencies

• Business Process Analysis
• Revenue Cycle Management Expertise
• Healthcare Domain Knowledge
• Requirements Documentation
• Problem Solving and Critical Thinking
• Stakeholder Management
• Communication and Presentation Skills
• Agile Methodologies
• Data-Driven Decision Making
• Cross-Functional Collaboration

Success Metrics

The Business Analyst will be evaluated on:

• Requirements quality and completeness
• Product delivery success rates
• Reduction in billing and claims processing issues
• Stakeholder satisfaction
• Development team efficiency
• Product adoption and customer feedback
• Revenue cycle performance improvements
• Regulatory and compliance adherence

This role directly contributes to the development of innovative billing solutions that optimize reimbursement, improve operational efficiency, and help healthcare organizations deliver exceptional patient care while maximizing financial performance.