Senior Business Analyst

MPower Plus; United States; Teletrabalho; USD 120 000 - 180 000; Tempo integral

Resumo da oferta

MPower Plus is seeking an experienced Business / Regulatory Analyst to support state-mandated Medicaid and healthcare payer compliance initiatives. The role involves translating complex regulations into clear business and system requirements with full traceability through implementation and audit.

Responsibilities include interpreting requirements, creating BRDs/FRDs/user stories, and coordinating with QA and stakeholder teams.

Qualificações

• 12+ years of experience as a Business or Regulatory Analyst
• 10+ years in healthcare payer
• Strong knowledge of the claims lifecycle, eligibility, and EDI transactions (834, 837, 835, 270/271)
• Experience working in Agile or SAFe environments

Responsabilidades

• Interpret Medicaid, CMS, and state regulatory requirements and assess operational and system impact
• Develop and maintain BRDs, FRDs, user stories, and RTMs
• Support initiatives across claims, eligibility and enrollment, prior authorization, and EDI integrations
• Partner with QA teams on regulatory test scenarios, validation, and audit readiness
• Collaborate with compliance, product, and technical stakeholders

Conhecimentos

Regulatory analysis

Agile / SAFe

Healthcare payer knowledge

Ferramentas

Facets

QNXT

HealthRules

Descrição da oferta de emprego

Business / Regulatory Analyst, Medicaid & Healthcare Payer

Location: Remote

Role Overview

We are seeking an experienced Business / Regulatory Analyst to support state-mandated Medicaid and healthcare payer compliance initiatives. The role involves translating complex state and federal regulations into clear business and system requirements, with full traceability through implementation and audit.

Key Responsibilities

• Interpret Medicaid, CMS, and state regulatory requirements and assess their operational and system impact
• Develop and maintain BRDs, FRDs, user stories, and requirements traceability matrices
• Support initiatives across claims, eligibility and enrollment, prior authorization, and EDI integrations
• Partner with QA teams on regulatory test scenarios, validation, and audit readiness
• Collaborate with compliance, product, and technical stakeholders

Required Qualifications

• 12+ years of experience as a Business or Regulatory Analyst, including 10+ years in healthcare payer
• Strong knowledge of the claims lifecycle, eligibility, and EDI transactions (834, 837, 835, 270/271)
• Experience working in Agile or SAFe environments

Preferred Qualifications

• Experience with Facets, QNXT, or HealthRules
• Familiarity with MMIS and Medicaid managed care operations