Remote Senior Business Systems Analyst – Healthcare Payers

HealthEdge Software, Inc.

United States

Remote

USD 120,000 - 125,000

Full time

14 days+

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Job summary

HealthEdge in the United States seeks a Senior Business Systems Analyst to capture business requirements for the Core admin ecosystem and drive implementation across claims, enrollment, provider and payment modules. You will lead requirements, collaborate with customers and vendors, and translate business needs into functional specs while guiding agile delivery in a remote-friendly environment.

The role emphasizes EDI transaction mapping, SQL/XSD familiarity, and cross-team coordination with

Qualifications

Knowledge of 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 to Agile tools and scrum methodologies.
Communication skills with peers, customers, and partners including the ability to convey information effectively.
Experience in analyzing the 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 HealthEdge applications like HealthRules Payer (HRP) or GuidingCare is a plus.
Understanding of SQL, XSDs is a plus.
Bachelor’s degree or higher in business or technical field, 10+ years of relevant work experience.

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 HealthEdge’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 analyzing 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.