Remote Health Payor Business Systems Analyst

UST; New York (NY); Remote; USD 104,000 - 156,000; Full time

Benefits offered by this job

401K matching

Paid time off

Health, dental, vision insurance

Life insurance

Disability insurance

Remote work option

Job summary

UST HealthProof is seeking a seasoned Business System Analyst to capture and translate payer domain requirements for core-admin ecosystems. You will work with Health Plan customers, vendors, IT, and product teams to define business rules for Claims, Enrollment, Provider, and Payment modules in a largely remote setting.

You will guide requirements, create functional specs, and ensure alignment with project plans.

Qualifications

• Knowledgeable in the Healthcare insurance domain (Medicare, Medicare Advantage, Medicaid, ACA, or Commercial).
• Exposure to healthcare ecosystems from partners like HealthEdge, TriZetto, NASCO, Advantasure, or Change Healthcare.
• Experience with mapping of EDI healthcare transactions (837, 834, 835, 270/271, 276/277, 278).
• Awareness of Agile tools and scrum methodologies.
• Communication skills with peers, customers, and partners including the ability to convey information effectively.
• Experience in analyzing business requirements and translating/mapping them to technical requirements in EDI technology by analyzing implementation/companion/TR3 guides.
• Experience documenting requirements or user stories and communicating the requirements to technical teams, partners/vendors, or product teams.
• Experience working in an onshore/offshore model is a must.
• Experience working with HealthEdge applications like HealthRules Payor or GuidingCare is a plus.
• Understanding of SQL and XSDs is a plus.
• Bachelor's degree or higher in business or technical field, 10+ years of relevant work experience in business analysis.

Responsibilities

• Leading business requirement conversations with customers and internal teams.
• Managing the end-to-end requirements involving all the stakeholders.
• Responsible for developing business and functional requirements for Claims, Enrollment, Provider, Authorization, and Payment systems.
• Create solutions for current business processes using UST HealthProof'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 by applying an Agile-like project methodology.
• Instrumental in analyzing the healthcare business requirements and translating them to functional and technical requirements.
• Identify opportunities for automation, performance improvements, and reusability.
• Develop high-level workflow diagrams and system context diagrams.
• Document the understanding of the process flow using swim lanes diagrams.
• Produce the Requirements plan that aligns with the overall Project Implementation plan.
• Dictate the risks and dependencies in a timely manner with the Customer to complete the requirement gathering to meet the project plan dates.
• Must work with Offshore Business Analysts to elaborate user stories.
• Conduct Requirements walk through with the customer and internal/external stakeholders.
• Collaborate with the development team & QA team to ensure the finished product meets project objectives and client expectations.
• Contribute towards sprint planning, retrospective, go-live/no go-live evaluation meetings.
• Conduct a Demo of MVPs for the customer.

Skills

Healthcare domain knowledge

EDI mapping experience

Agile / Scrum familiarity

Communication skills

Requirements analysis

Requirements documentation

Onshore/offshore model experience

SQL knowledge

XSD knowledge

Stakeholder collaboration

Education

Bachelor's degree or higher in business or technical field

10+ years of business analysis experience

Tools

HealthEdge HealthRules Payor

GuidingCare

Change Healthcare

EDI tooling

Job description

UST HealthProof is seeking a seasoned Business System Analyst to capture and translate payer domain requirements for core-admin ecosystems. You will work with Health Plan customers, vendors, IT, and product teams to define business rules for Claims, Enrollment, Provider, and Payment modules in a largely remote setting.

You will guide requirements, create functional specs, and ensure alignment with project plans.