Remote Health Plan Business Analyst Core Admin & EDI

HealthEdge Software, Inc.; United States; Remote; USD 100,000 - 115,000; Full time

Job summary

HealthEdge seeks a seasoned Business System Analyst to join a US-based, remote/hybrid team supporting core HealthEdge admin ecosystems. You will capture and translate business and functional requirements for Claims, Enrollment, Provider, Authorization and Payment systems, and drive alignment with customers, vendors, and offshore teams.

The role requires 10+ years in healthcare business analysis, strong EDI knowledge (837/834/835,270/271, 276/277, 278), SQL/XSD familiarity, and experience with

Qualifications

• Knowledgeable in Healthcare insurance domain (Medicare, Medicaid, ACA or Commercial).
• Experience mapping healthcare EDI transactions (837, 834, 835,270/271, 276/277, 278).
• Awareness to Agile tools and scrum methodologies.
• Experience documenting requirements or user stories and communicating the requirements to technical teams, partners/vendors or product teams.
• Experience in analysing the business requirements and translating/mapping them to technical requirements in EDI technology.

Responsibilities

• Leading business requirement conversations with customer 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, Payment systems.
• Create solutions for current business processes using UST HealthProof’s core-admin ecosystem.
• Negotiate with client to develop processes that are current and applicable to the situation.
• Collaborate with business users, management, IT, and offshore staff to ensure the finish product meets project objectives and client expectations by applying Agile like project methodology.
• Instrumental in analysing the healthcare business requirements and translating them to functional and technical requirements
• Identify opportunities for automation, performance improvements, 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 the timely manner with the Customer to complete the requirement gathering to meet up with the project plan dates.
• Must work with Offshore Business Analysts to elaborate user stories
• Conduct Requirement walk through with the customer and internal/external stakeholders
• Collaborate with the development team & QA team to ensure the finish product meets project objectives and client expectations.
• Contribute towards sprint planning, retrospective, go-live/no go-live evaluation meetings.
• Conduct Demo of MVPs for the customer.

Skills

Healthcare domain

EDI mapping

Agile methodologies

Communication skills

Requirements analysis

Onshore/offshore model

HealthEdge apps

SQL/XSDs

10+ years experience

Education

Bachelor’s degree or higher in business/technical field

Job description

HealthEdge seeks a seasoned Business System Analyst to join a US-based, remote/hybrid team supporting core HealthEdge admin ecosystems. You will capture and translate business and functional requirements for Claims, Enrollment, Provider, Authorization and Payment systems, and drive alignment with customers, vendors, and offshore teams.

The role requires 10+ years in healthcare business analysis, strong EDI knowledge (837/834/835,270/271, 276/277, 278), SQL/XSD familiarity, and experience with