business systems analyst - healthcare payer domain required(12+yrs exp, needed/0- Remote

[Radha Venkatraman]

 

Dear friends,

 Please respond with suitable profiles with contact details, visa copy, DL, Passport number and linkedin for the below urgent requirement.

 Position: Business systems analyst (12+yrs exp. Needed)

Location: Remote - PST

Type: long term contract

Rate: open

Position summary:

 

• Top 3 must have skillsets

o Direct Experience in Availity transactions including Eligibility & Benefits (270/271), Claims Status (276/277), Prior Authorization (278), Attachments, and Claims (837/835).

o Healthcare payer business system analyst

o SQL

 

Responsibilities

Primary duties may include, but are not limited to:

• Conducts end-to-end analysis of payer and provider workflows involving Availity transactions including Eligibility & Benefits (270/271), Claims Status (276/277), Prior Authorization (278), Attachments, and Claims (837/835).

• Evaluates business requirements, integration patterns, and data flows to ensure alignment with Availity capabilities and enterprise-level operational expectations.

• Reviews Availity response data, error codes, payer-specific rules, and transaction-level exceptions to validate accuracy, completeness, and adherence to EDI standards.

• Supports implementation, enhancement, and optimization of Availity portal features, API integrations, and clearinghouse configurations.

• Leads requirement-gathering sessions with operations, product teams, and technical stakeholders; documents functional requirements, user stories, acceptance criteria, and workflow diagrams.

• Assesses business impact of Availity-related changes, EDI mapping updates, and upstream/downstream process modifications.

• Performs root cause analysis for transaction failures, rejections, eligibility discrepancies, and authorization processing issues.

• Develops test plans, executes UAT, and validates end-to-end transaction integrity for enhancements related to Availity workflows.

• Prepares documentation, reporting summaries, analysis logs, and communication materials for both technical and non-technical teams.

• Conducts research and evaluation of clearinghouse rules, EDI compliance requirements, and payer implementation guides.

• May provide SME guidance to project teams and serve as a resource for Availity operations, payer-provider transactions, and healthcare EDI standards.

 

Requirements

• Bachelor’s degree in Healthcare Administration, Information Systems, Business, or a related field; minimum of 5 years of experience as a Healthcare Business Analyst within a payer or provider environment.

• Hands-on experience with Availity Portal, Availity APIs, or clearinghouse integrations is required.

• Strong understanding of HIPAA-standard EDI transactions (270/271, 276/277, 278, 837, 835) and healthcare administrative operations.

• Experience documenting business requirements, process flows, and business rules across eligibility, claims processing, and authorization domains.

• Familiarity with healthcare data protection expectations and payer/provider transaction guidelines.

• Experience supporting business operations, compliance reviews, or audit-related activities in a healthcare context.

• Ability to analyze transaction data, troubleshoot integration issues, and interpret Availity error responses and payer communication.

• Strong written and verbal communication skills, including the ability to develop clear documentation and communicate findings effectively.

• Comfortable working with cross-functional U.S.-based teams and managing business discussions directly with stakeholders.

• Proficiency with productivity and analysis tools such as MS Word, MS Excel, JIRA, Confluence, and standard EDI/Availity reporting formats.

Years of Experience:     12.00 Years of Experience

 

 

 

Regards,

Radha Venkatraman

Recruitment Lead
ReqRoute,Inc
Desk: 408-600-2008; Fax: 888-400-2698
Email: ra...@reqroute.com