Business Systems Analyst lll

Fallon Health • Worcester, MA

5d

About The Position

Fallon Health is seeking a Business Systems Analyst III to work on projects that generally involve a complex scope. The role analyzes and documents business requirements and workflows, develops file mappings and technical specifications, and works with business partners and stakeholders to prioritize requirements. It assesses system capabilities and interdependencies to define and document business solutions, collaborates with development teams, and provides complex technical guidance using effective design concepts. The analyst proposes or seeks alternative solutions to balance business and technical needs.

The position provides ongoing business systems analysis and production support for Enrollment, Billing & Provider (EBP) applications and processes, particularly eligibility, enrollment, billing, reconciliation, and outbound vendor file processing. It serves as a lead analyst for complex eligibility and vendor-file initiatives and supports annual Medicare and other product implementations, operational reconciliation, and process improvement.

Permanent work authorization in the U.S. is required. Fallon Health will not provide visa sponsorship or accept candidates on OPT/CPT. Applicants must be located in one of the eligible states: Massachusetts, Connecticut, Rhode Island, New Hampshire, or New York (excluding the boroughs).

Requirements

• Bachelor’s degree or equivalent experience preferred.
• 5 to 10 years of business analysis, process mapping, or equivalent experience.
• At least 5 years of experience writing technical specifications or equivalent experience.
• At least 5 years of data analysis experience in an information technology operating environment or equivalent experience.
• Two years of healthcare industry experience required.
• Excellent understanding of data warehousing concepts, relational databases, and their business applicability in healthcare management.
• Intermediate knowledge of SQL and relational technology, with proficient query-writing experience or equivalent experience.
• Permanent work authorization in the U.S.; visa sponsorship is not provided, and candidates on OPT/CPT are not accepted.
• Must be located in Massachusetts, Connecticut, Rhode Island, New Hampshire, or New York, excluding the boroughs.

Nice To Haves

• Demonstrated experience with healthcare enrollment, eligibility, billing, provider data, and/or EDI transaction processing.
• Experience with 834/820 transactions, vendor-file interfaces, reconciliation processes, and healthcare payer systems.

Responsibilities

• Provide ongoing business systems analysis and production support for Enrollment, Billing & Provider applications and processes, with focus on eligibility, enrollment, billing, reconciliation, and outbound vendor file processing.
• Lead complex eligibility and vendor-file initiatives, including requirements gathering, business-rules analysis, file mapping, BRD development and updates, testing coordination, defect resolution, and implementation support.
• Analyze and document healthcare EDI and enrollment-related data requirements and mappings, including 834 and 820 transaction processing and associated reconciliation workflows.
• Partner with business stakeholders, developers, QA, EDI/Integration teams, and external vendors to translate business needs into technical requirements, resolve data or processing issues, and coordinate testing and implementation activities.
• Support annual Medicare and other product implementation activities by conducting impact assessments, identifying affected applications and files, defining required changes, documenting requirements, and coordinating readiness across impacted units.
• Support operational reconciliation and process-improvement initiatives, identifying opportunities to automate or standardize file validation, exception handling, monitoring, and business handoffs.
• Analyze and document business requirements and workflows, develop file mappings and technical specifications, and work with stakeholders to prioritize requirements.
• Assess system capabilities and interdependencies to define and document business solutions, and provide technical guidance to development teams.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior