Sr. Healthcare Business Analyst/Quality

ELLKAY, LLC; United States; Hybrid; USD 100,000 - 150,000; Full time

Benefits offered by this job

Medical, Dental, and Vision benefits

Remote work options

401k with matching

Job summary

ELLKAY in the United States seeks a Senior Healthcare Business and Quality Analyst to bridge product management, operations, clinical SMEs, and QA. You will translate regulations and data behavior into testable requirements and maintain end-to-end traceability.

The role emphasizes business analysis over test execution, with responsibilities spanning requirements elicitation, process modeling, data definitions, and partner alignment across claims, enrollment, billing, and reporting.

Qualifications

• Bachelor's degree or equivalent practical experience in a related field.
• 6+ years in business or systems analysis with healthcare products, operations, data, or interoperability.
• Ability to create precise requirements, acceptance criteria, process models, and traceability artifacts in Agile environments.
• Strong knowledge of healthcare domains such as claims, eligibility, enrollment, benefits, and provider data.

Responsibilities

• Elicit, analyze, document, and validate business, functional, data, integration, reporting, and regulatory requirements for healthcare products and programs.
• Bridge between product management, operations, clinical SMEs, engineering, data teams, and QA; translate business intent into actionable language.
• Develop process flows, use cases, decision tables, business rules, data definitions, interface expectations, and acceptance criteria.
• Ensure clarity, completeness, consistency, feasibility, traceability, and testability of requirements; surface gaps and edge cases early.
• Provide QA with domain context, expected outcomes, priority scenarios, and risk-based coverage guidance.
• Analyze workflows and data across claims, benefits, eligibility, enrollment, member/provider management, authorizations, billing, payments, pharmacy, and related functions.
• Interpret HL7, FHIR, X12 EDI standards to validate business meaning and mapping intent.
• Maintain end-to-end traceability from business objectives through requirements, acceptance criteria, QA coverage, defects, and release decisions.
• Facilitate requirement reviews, story refinement, defect triage, UAT planning, and business sign-off.

Skills

Business analysis

Requirements elicitation

Agile delivery

QA liaison

Healthcare domain knowledge

Education

Bachelor's degree in business, healthcare administration, information systems, public health, or related

Tools

HL7

FHIR

X12 EDI

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Sr. Healthcare Business Analyst/Quality

Engineering Shared Services Full Time US

ELLKAY started out providing connectivity solutions to laboratories and within a few years, grew to also provide data management solutions to ambulatory organizations. ELLKAY is now a trusted data management partner in five healthcare segments. ELLKAY’s solutions continue to serve laboratories and ambulatory practices and have expanded to empower hospitals and health systems, healthcare IT vendors, ambulatory practices, health plans, and other healthcare organizations with cutting-edge technologies and solutions that drive their growth and interoperability strategies. Today, ELLKAY remains true to our core values, building strong partner relationships and offering unparalleled service and support while providing innovative, scalable solutions to the challenges our customers face in today’s data-rich world. ELLKAY's experience, customer-focused approach, and reputation for innovation, speed, and accuracy differentiate ELLKAY as a premier partner for your interoperability needs and data management strategy.

Job Description:

The Senior Healthcare Business and Quality Analyst is the primary requirements and domain-analysis partner for Quality Engineering. The role translates product intent, healthcare operations, regulations, and data behavior into clear, testable requirements and serves as a subject-matter reference for QA. Its emphasis is business analysis and domain accuracy rather than test execution ownership.

Key responsibilities

• Elicit, analyze, document, and validate business, functional, data, integration, reporting, and regulatory requirements for healthcare products and programs.
• Serve as the bridge among product management, operations, clinical or healthcare SMEs, engineering, data teams, and QA; translate business intent into language each group can act on.
• Develop process flows, use cases, decision tables, business rules, data definitions, interface expectations, acceptance criteria, and end-to-end scenario models.
• Assess requirements for clarity, completeness, consistency, feasibility, traceability, and testability; surface conflicts, missing decisions, and edge cases early.
• Provide QA with domain context, expected outcomes, priority scenarios, healthcare terminology, operational exceptions, and risk-based coverage guidance.
• Analyze workflows and data across claims, benefits, eligibility, enrollment, member and provider management, authorizations, clinical exchanges, billing, payments, pharmacy, or related healthcare functions.
• Interpret healthcare formats and standards such as HL7, FHIR, X12 EDI, code sets, and payer or provider data exchanges sufficiently to validate business meaning and mapping intent.
• Maintain end-to-end traceability from business objectives and regulatory obligations through requirements, acceptance criteria, QA coverage, defects, and release decisions.
• Facilitate requirement reviews, story refinement, three-amigo sessions, defect triage, UAT planning, and business sign-off; distinguish requirement gaps, configuration issues, data-quality problems, workflow misunderstandings, and software failures.
• Support UAT by preparing business scenarios, coordinating participants, clarifying expected results, and synthesizing findings for product and QA leadership.
• Monitor healthcare policy, contractual, and operational changes; perform impact analysis and advise teams on affected workflows, data, and validation needs.

Required qualifications

• Bachelor's degree in business, healthcare administration, information systems, public health, or a related discipline, or equivalent practical experience.
• Typically 6+ years in business or systems analysis, including deep experience with healthcare products, operations, data, or interoperability.
• Demonstrated ability to create precise requirements, acceptance criteria, process models, business rules, and traceability artifacts in Agile delivery environments.
• Strong knowledge of at least two healthcare domains, such as claims, eligibility and enrollment, benefits, provider, clinical, utilization management, pharmacy, or payment integrity.
• Understanding of software quality practices sufficient to make requirements testable, guide coverage, and evaluate business impact without assuming the role of primary test engineer.
• Excellent facilitation, critical thinking, negotiation, documentation, and executive-ready communication skills.

Preferred qualifications

• Experience with HIPAA-regulated systems, CMS or state programs, payer or provider operations, and healthcare interoperability initiatives.
• Relevant credentials such as CBAP, PMI-PBA, CSPO, AHIP, or domain-specific healthcare certification.

ELLKAY offers a comprehensive and competitive benefit package that starts day one!

Including:

• Medical, Dental, and Vision benefits
• Employer-paid Life and LTD
• 401k w/ matching – once eligibility is met
• Work/life balance
• Generous FTO
• Remote work options
• Employee Discounts

Our awesome culture includes:

• Working with talented, collaborative, and friendly people who love what they do
• Professional growth within
• Innovation environment
• On site in HQ Free daily lunches

Additional information

At ELLKAY, we are committed to operating as a hybrid workplace, offering employees flexibility in how they structure their time between in-office and remote work. We recognize the significance of fostering connections, collaboration, and creativity within our office culture and its positive impact on our business. Our philosophy of operating as a hybrid workplace underscores our dedication to enabling employees to tailor work-life balance to their individual preferences. For those who do not live within 40 miles of one of our offices, we are open to considering remote work for candidates whose skills and experience strongly align with the role. While we prioritize a hybrid work environment for most roles, we understand the importance of flexibility and are open to remote work for specific positions and specialized skill sets.

For more information on our company, visit www.ELLKAY.com.

ELLKAY LLC is a Smoke-Free Workplace.

ELLKAY, LLC provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.