Sr Business Analyst - Health Care Domain
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9:53 AM (11 hours ago) 9:53 AM
to Sharath Sharath
JOB ROLE: Sr Business Analyst
Health CAre Experience with
EDI transactions mandatory
Remote
Exp: 12+ years
JOB DESCRIPTION:
We are seeking a highly skilled Business Analyst with strong experience in healthcare
domain, provider systems, and EDI transactions, particularly those related to claims,
eligibility, enrollment, and authorizations.
This individual will support initiatives within the Provider Portal team, driving
requirements, systems analysis, and cross-functional collaboration. The ideal candidate is
proactive, technically inclined, and capable of taking end-to-end ownership of deliverables
in a dynamic environment.
Key Responsibilities
• Gather, analyze, and document business, functional, and system requirements for
Provider Portal enhancements and new features.
• Work closely with business stakeholders, provider operations teams, product
owners, and technical teams to translate needs into clear technical requirements.
• Analyze and interpret EDI transaction sets (e.g., 837, 835, 270/271, 278, etc.),
understanding loops, segments, and mapping requirements.
• Conduct impact analysis related to provider workflows: claims,
eligibility/benefits, prior authorizations, appeals/grievances, and credentialing.
• Collaborate with developers, QA team, integration teams, and architecture to
ensure requirements are accurately implemented.
• Support QA by reviewing test cases, performing functional validation, and assisting
with defect triage.
• Lead discussions, workshops, and working sessions with cross-functional teams.
• Act as the liaison between business and IT for clarifications, prioritization, and issue
resolution.
• Track project progress, risks, and dependencies; proactively follow up with teams to
ensure timely delivery.
• Support UAT planning, coordination, and execution.
• Provide documentation including BRDs, user stories, acceptance criteria, use
cases, workflow diagrams, and data mapping documents.
Required Skills & Experience
Healthcare Domain
• Strong experience in healthcare provider or payer systems
• Understanding of key processes such as claims processing, eligibility/benefits,
prior authorization, provider data management, appeals, and overall provider
workflows.
• Prior IBC experience is a must-have
EDI Expertise
• Hands-on experience with major EDI transaction sets:
o 837 (claims)
o 835 (remits)
o 270/271 (eligibility)
o 278 (prior authorization)
o 999/277CA (acknowledgments)
• Ability to read, interpret, and analyze EDI files including loops, segments, qualifiers,
and mapping logic.
Business Analysis
• Strong background in requirements elicitation, documentation, and stakeholder
communication.
• Experience writing user stories, use cases, process flows, data mapping, and
acceptance criteria.
• Strong analytical thinking and problem-solving skills.
Soft Skills
• Excellent communication skills with the ability to articulate complex concepts to
both business and technical stakeholders.
• High level of proactiveness—takes initiative, asks questions, follows up, and drives
issues to closure.
• Strong leadership and ownership mindset—comfortable leading meetings and
driving deliverables end-to-end.
Technical Skills
• Familiarity with web-based portal systems, APIs, integration workflows, and
backend data flow.
• Ability to perform light SQL queries for validation (preferred).
• Experience working with Agile/Scrum methodology and tools like JIRA, Azure
DevOps, or similar.
• Experience working specifically with provider portals (claims status, authorization
status, PCP assignment, provider search, etc.).
• Background supporting Medicaid/Medicare lines of business.
• Experience with system integration projects or modernization efforts.
• Knowledge of FHIR and HL7 (bonus).
• Prior experience in a C2H environment or enterprise-level healthcare IT setting.
-- • Gather, analyze, and document business, functional, and system requirements for
Provider Portal enhancements and new features.
• Work closely with business stakeholders, provider operations teams, product
owners, and technical teams to translate needs into clear technical requirements.
• Analyze and interpret EDI transaction sets (e.g., 837, 835, 270/271, 278, etc.),
understanding loops, segments, and mapping requirements.
• Conduct impact analysis related to provider workflows: claims,
eligibility/benefits, prior authorizations, appeals/grievances, and credentialing.
• Collaborate with developers, QA team, integration teams, and architecture to
ensure requirements are accurately implemented.
• Support QA by reviewing test cases, performing functional validation, and assisting
with defect triage.
• Lead discussions, workshops, and working sessions with cross-functional teams.
• Act as the liaison between business and IT for clarifications, prioritization, and issue
resolution.
• Track project progress, risks, and dependencies; proactively follow up with teams to
ensure timely delivery.
• Support UAT planning, coordination, and execution.
• Provide documentation including BRDs, user stories, acceptance criteria, use
cases, workflow diagrams, and data mapping documents.
Required Skills & Experience
Healthcare Domain
• Strong experience in healthcare provider or payer systems
• Understanding of key processes such as claims processing, eligibility/benefits,
prior authorization, provider data management, appeals, and overall provider
workflows.
• Prior IBC experience is a must-have
EDI Expertise
• Hands-on experience with major EDI transaction sets:
o 837 (claims)
o 835 (remits)
o 270/271 (eligibility)
o 278 (prior authorization)
o 999/277CA (acknowledgments)
• Ability to read, interpret, and analyze EDI files including loops, segments, qualifiers,
and mapping logic.
Business Analysis
• Strong background in requirements elicitation, documentation, and stakeholder
communication.
• Experience writing user stories, use cases, process flows, data mapping, and
acceptance criteria.
• Strong analytical thinking and problem-solving skills.
Soft Skills
• Excellent communication skills with the ability to articulate complex concepts to
both business and technical stakeholders.
• High level of proactiveness—takes initiative, asks questions, follows up, and drives
issues to closure.
• Strong leadership and ownership mindset—comfortable leading meetings and
driving deliverables end-to-end.
Technical Skills
• Familiarity with web-based portal systems, APIs, integration workflows, and
backend data flow.
• Ability to perform light SQL queries for validation (preferred).
• Experience working with Agile/Scrum methodology and tools like JIRA, Azure
DevOps, or similar.
• Experience working specifically with provider portals (claims status, authorization
status, PCP assignment, provider search, etc.).
• Background supporting Medicaid/Medicare lines of business.
• Experience with system integration projects or modernization efforts.
• Knowledge of FHIR and HL7 (bonus).
• Prior experience in a C2H environment or enterprise-level healthcare IT setting.
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