Senior Business Analyst

Credence Global Solutions; Pune District; Vor Ort; INR 1.500.000 - 2.300.000; Vollzeit

Zusammenfassung

Credence Resource Management seeks a seasoned health care RCM professional to validate platform outputs, shape synthetic data realism, and drive testing and vendor engagements. You will classify detections, review confidence scores, and help define next steps in collaboration with engineers.

The role emphasizes deep payer contract knowledge, data interpretation, and the ability to translate domain logic into scalable system behavior for platform evolution.

Qualifikationen

• Six to ten years of health care RCM experience.
• Experience with ambiguous or conflicting data.
• Deep knowledge of payer contracts, fee schedules and MCO products.
• Expertise in at least one RCM process area (appeals, denials, A/R follow-up, posting).
• Ability to explain domain logic to engineers without coding.

Aufgaben

• Validate platform outputs against real-world expectations.
• Define realistic synthetic data characteristics for development.
• Review outputs, classify true vs. false positives, and validate confidence scores.
• Engage in vendor evaluations, technical reviews, and edge-case discussions.
• Help shape the long-term platform vision and evolution.

Kenntnisse

SQL proficiency

Advanced Excel

Data interpretation

Domain knowledge

Communication

Tools

Snowflake

Redshift

BigQuery

Jobbeschreibung

Product Development

Job Roles & Responsibilities

1. Be the Operational \"Truth Source\" for the Platform
   You will be accountable for validating that platform outputs make sense in the real world. This includes:

• Reviewing payer contracts, amendments, and fee schedules
• Interpreting real-world contract logic (lesser-of, modifiers, MCO products, effective dates)
• Reading raw 835 remits and identifying:
  Reimbursement issues vs legitimate adjustments
  Payer miss configuration vs provider error
  Systemic vs one-off issues
• Calling out false positives and explaining why something is not a true issue
  If something looks \"technically correct\" but operationally wrong, you are expected to stop it.

1. Own Synthetic Data Realism (Critical)
   The platform will initially rely on synthetic data for development and validation. You will:

• Define what \"realistic\" synthetic data looks like: payer mix, CARC/RARC distributions, modifier usage
  patterns, underpayment frequency and dollar impact
• Review synthetic data sets and flag unrealistic assumptions
• Guide engineers and vendors on correcting synthetic data generation logic
  This role protects the credibility of everything we build.

1. Be Deeply Embedded in Testing & Validation
   You will be hands‑on in:

• Reviewing detection outputs and classifying true vs false positives
• Validating confidence scores against operational reality
  Effective – February 12, 2026
  Credence Resource Management
  v1.0
• Helping define \"suggested next step\" classifications (appeal, rebill, review, do not pursue)
• Testing against real customer data during pilot phases
  Your feedback will directly shape detection logic, confidence thresholds, and future AI agent behavior. You are
  effectively the human-in-the-loop backbone of the system.

1. Act as the RCM Counterweight in Vendor Engagements
   You will actively participate in vendor evaluations, technical reviews, and edge‑case discussions. You will:

• Ask uncomfortable but necessary questions
• Spot hand‑wavy answers around contracts or EDI
• Distinguish between \"can build,\" \"has built,\" and \"is guessing\"
  This role is critical to holding vendors accountable and ensuring delivery meets operational standards.

1. Help Carry the Long-Term Platform Vision Forward
   While the MVP starts with underpayments, the platform is designed to evolve toward:

• Broader reimbursement correctness (denials, old AR, charge capture)
• Recommendation intelligence and outcome monitoring
• Selective automation with AI agents
• Contract renegotiation insights
  You will help ensure core data models are reusable, intelligence is generalized, and we don't hard‑code short
  term assumptions that block long‑term evolution.

Candidate Requirements

Experience & Domain Expertise

• 6-10+ years in health care RCM — revenue integrity, payer contracts, payment analysis, denials, or A/R
• Experience working with ambiguous or conflicting data
• Deep knowledge of payer contracts and fee schedules — percent of Medicare, lesser‑of, MCO products,
  modifier rules, effective dates
• Deep knowledge of the RCM data ecosystem — claims, remittances, fee schedules, industry
  benchmarks, regulatory references, and how they connect
• Deep expertise in at least one RCM process area (appeals, denials, A/R follow‑up, payment posting) —
  you'll help design how AI agents execute these work flows
  Judgment & Mindset
• Strong judgment in gray areas where contracts, data, and payer behavior don't line up
• Willingness to challenge assumptions — included those from engineers and vendors
• Comfortable saying \"this would never happen in production\"
• Builder mentality: you like shaping systems, not just running reports
• Technical Comfort (Not a Data Scientist)
• SQL proficiency — ability to query data, validate outputs, build test cases
• Advanced Excel — pivot tables, VLOOKUP/INDEX-MATCH, large data set manipulation
• Comfortable working with raw data (CSV, JSON, EDI extracts)
• Able to explain domain logic clearly to engineers — you don't need to code but you must understand
  how logic translates into systems
• Preferred (Nice to Have)
• Experience with lab billing (CLFS) or physician billing (PFS) — ideally both
• Background in underpayment recovery, contract audits, or payer disputes
• Familiarity with Medicare fee schedules and locality adjustments (GPCI)
• Experience with data warehouses (Snowflake, Redshift, BigQuery)
• Prior experience in a startup or product development environment

Kindly Note: At Credence, we uphold the highest standards of integrity in our recruitment process. We
do not charge any fees at any stage of the hiring process, and we strictly prohibit any third parties,
vendors, or individuals from soliciting money in exchange for job opportunities at Credence.
If you are approached by anyone requesting payment or offering you a position at Credence in exchange
for money, do not engage with them. Such actions are fraudulent and not authorized by Credence.

Please report any such incidents immediately to our official HR team at [e-mail]
Your safety and trust are important to us. Thank you for helping us maintain a fair and transparent hiring
environment.