Business Analyst (healthcare payer)

TechDigital Group; Longview (WA); On-site; USD 60,000 - 100,000; Full time

Job summary

An established industry player is seeking a skilled Business Analyst with a strong background in the healthcare payer sector. This role involves translating complex business needs into clear, actionable requirements and analyzing data to identify and solve business challenges. The ideal candidate will possess extensive knowledge of claims, billing, and enrollment processes, as well as a solid understanding of compliance policies. With a focus on collaboration and communication, you will work with teams to enhance business growth and ensure adherence to industry standards. If you are passionate about driving innovation in healthcare, this opportunity is perfect for you.

Qualifications

• 5+ years of experience in healthcare payer industry.
• Strong analytical skills to identify business problems and solutions.

Responsibilities

• Translate business needs into detailed requirements for new applications.
• Analyze data to determine business problems and recommend changes.

Skills

Healthcare Payor Industry Knowledge

Claims Analysis

Billing and Enrollment Platforms

Medicare and Medicaid Reporting

Risk Adjustment

Business Intelligence

Data Mapping

Analytical Skills

Communication Skills

Tools

JIRA

MS Word

MS Excel

MS Access

Job description

Business Analyst (healthcare payer) - Healthcare Insurance is required - (claims, billing, and enrollment)

Job Description: Healthcare Business Consultant/Analyst translates business needs into clearly defined and documented detailed, high quality requirements and/or supplemental specifications for new applications or analyzes change requests/enhancements in existing applications. Analyzes data to determine business problems. The Consultant/Analyst works collaboratively within or outside the team to identify charge system weakness, to recommend changes and focused education. Will also ensure adherence to compliance policies and contracts. Knowledge and experience of Healthcare (Payor/Provider) industry along with go-getter attitude to drive business growth & excellent communication skills.

Key Skills and Responsibilities:

1. Minimum of 5 years of strong payer background
2. Knowledge and experience of Healthcare Payor industry & understanding of latest trends & innovation
3. Reviews, analyzes, and evaluates business processes and associated IT application requirements.
4. Knowledge and experience in the following core areas:
   1. Claims knowledge and experience is a must
   2. Enrollment & Billing platforms
   3. Medicare & Medicaid state level reporting levels
   4. Knowledge/Experience of HEDIS/Star Rating
   5. Medical Record Retrieval/Provider Engagement Coordination
   6. Risk Adjustment & Business Intelligence
   7. Strong understanding of healthcare data formats, standards, and can map them to CMS and state level reporting needs.
5. Develops and executes test strategies, plans, scenarios, and tracks resolution to identified defects.
6. Defines and documents business and IT system processes. Models AS-IS and TO-BE processes.
7. Conducts and facilitates JAD sessions to develop and coordinate requirements, specifications, design, and testing efforts for medium to large projects.
8. Analyzes business workflow and system needs for conversions and migrations; assists in data mapping.
9. Conducts gap analysis and uses analytical skills to identify root cause and assist with problem management.
10. Defines and develops test plan documentation to support system validation and/or User Acceptance Testing.

Additional Skills:

1. Process improvements & worked on requirement gathering tool such as JIRA etc.
2. Moderate to high end personal computer skills including MS Word and Excel.
3. Past use of any database program such as MS Access is a plus
4. Excellent written & spoken communication skills