Sr. Business Analyst

HealthEdge•Remote,

6d•$120,000 - $125,000•Remote

About The Position

The Senior Business Systems Analyst captures business requirements for health plan customers’ core administration functions while implementing HealthEdge’s core-admin ecosystem. The role works with customers, third-party vendors and partners, internal product teams, solution architects, and product owners to define the business rules and processes required for implementation. The candidate should have deep experience in healthcare payer domains such as claims adjudication, enrollment, provider, and payment, along with strong requirements elicitation and communication skills. The analyst identifies customer problems and works with solution architects to develop solutions. The role includes analyzing healthcare business requirements and translating them into functional and technical requirements, creating solutions for current business processes using HealthEdge’s core-admin ecosystem, and collaborating with business users, management, IT, offshore staff, development, and QA teams. The analyst supports implementation planning and Agile-like project activities, including sprint planning, retrospectives, go-live decisions, and customer demonstrations. The position is remote in the United States, includes work across time zones, and may require travel of up to 25%.

Requirements

Knowledge of healthcare insurance domains, including Medicare, Medicare Advantage, Medicaid, ACA, or Commercial.
Experience mapping EDI healthcare transactions, including 837, 834, 835, 270/271, 276/277, and 278.
Awareness of Agile tools and Scrum methodologies.
Effective communication with peers, customers, and partners, including the ability to convey information clearly.
Experience analyzing business requirements and translating or mapping them to technical requirements in EDI technology using implementation, companion, and TR3 guides.
Experience documenting requirements or user stories and communicating them to technical teams, partners, vendors, or product teams.
Experience working in an onshore/offshore model.
Bachelor’s degree or higher in a business or technical field.
10 or more years of relevant business analysis experience.

Nice To Haves

Exposure to healthcare ecosystems and partners such as HealthEdge, TriZetto, NASCO, Advantasure, or Change Healthcare.
Experience working with HealthEdge applications such as HealthRules Payer (HRP) or GuidingCare.
Understanding of SQL and XSDs.

Responsibilities

Lead business requirements conversations with customers and internal teams.
Manage end-to-end requirements involving all stakeholders.
Develop business and functional requirements for claims, enrollment, provider, authorization, and payment systems.
Create solutions for current business processes using HealthEdge’s core-admin ecosystem.
Negotiate with clients to develop processes that are current and applicable to the situation.
Collaborate with business users, management, IT, and offshore staff to ensure the finished product meets project objectives and client expectations, applying an Agile-like project methodology.
Analyze healthcare business requirements and translate them into functional and technical requirements.
Identify opportunities for automation, performance improvements, and reusability.
Develop high-level workflow diagrams and system context diagrams.
Document process-flow understanding using swim-lane diagrams.
Produce a requirements plan aligned with the overall project implementation plan.
Communicate risks and dependencies to the customer in a timely manner to complete requirements gathering according to project plan dates.
Work with offshore Business Analysts to elaborate user stories.
Conduct requirements walkthroughs with the customer and internal and external stakeholders.
Collaborate with development and QA teams to ensure the finished product meets project objectives and client expectations.
Contribute to sprint planning, retrospectives, and go-live/no-go-live evaluation meetings.
Conduct customer demonstrations of MVPs.