Business Systems Analyst lll

Fallon Health • Worcester, MA

7d

About The Position

The Business Systems Analyst III works on projects with generally 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. The analyst assesses system capabilities and interdependencies to define and document business solutions, collaborates with development teams, provides complex technical guidance, and applies effective design concepts. The role also proposes or seeks alternative solutions to balance business and technical needs.

The position provides 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 lead analyst on complex eligibility and vendor file initiatives and supports Medicare and other product implementation activities, 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 MA, CT, RI, NH, or NY (excluding the boroughs specified in the posting).

Requirements

• Requires 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 experience in data analysis in an information technology operating environment or equivalent experience.
• 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.
• Two years of healthcare industry experience required.
• Permanent work authorization in the U.S.; visa sponsorship is not available, and OPT/CPT candidates are not accepted.
• Must be located in MA, CT, RI, NH, or NY, excluding the boroughs specified in the posting.

Nice To Haves

• Bachelor’s degree or equivalent experience preferred.
• 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 (EBP) applications and processes, particularly 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.
• Support annual Medicare and other product implementations by performing impact assessments, identifying affected applications and files, defining 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.

What This Job Offers

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