Sr. Business Analyst

HealthEdge provides AI-powered operational infrastructure and core-administration technology for health insurance companies. The Senior Business Systems Analyst will capture and translate healthcare payer business requirements into functional and technical requirements while implementing HealthEdge’s core-admin ecosystem. The role leads stakeholder discussions, designs process and workflow solutions, manages requirements, and collaborates with customers, architects, product, development, and QA teams through implementation.

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

Requirements:

• The Candidate should possess deep knowledge & experience in healthcare payer domains (Claims adjudication, Enrollment, Provider, Payment)
• He / She should have excellent requirement elicitation and communication skills and ability to engage as part of a team working both physically and virtually
• Also, he / she should be able to identify the customer problems and work with Solution Architect(s) to provide the solution to customer
• Knowledge of the healthcare insurance domain (Medicare, Medicare Advantage, Medicaid, ACA or Commercial)
• 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
• Bachelor's degree or higher in business or technical field, 10+ years of relevant work experience in business analysis
• Exposure to healthcare eco-systems from partners like HealthEdge, TriZetto , NASCO, Advantasure or Change Healthcare
• Experience working HealthEdge applications like HealthRules Payer (HRP) or GuidingCare is a plus
• Understanding of SQL, XSDs is a plus