Senior Business Analyst

Overview

• VBC & Payer/Provider Expertise: Lead analysis efforts for Value-Based Care initiatives, including shared savings, risk adjustment, quality metric tracking (HEDIS, CMS Star Ratings, MIPS), and provider performance analytics.


• Requirement Gathering: Elicit, analyze, and document complex business requirements (BRD), functional specifications (FRD), and user stories for claims processing, enrollment, and provider data management.


• Data Analysis & Mapping: Perform data mapping and analysis on EDI transactions (837I/P, 835, 270/271, 834) to support interoperability and reporting needs.


• Process Modeling: Map "As-Is" and "To-Be" workflows to improve provider/payer connectivity and operational efficiency.


• Stakeholder Collaboration: Act as the liaison between business units (clinical operations, finance, network management) and IT teams to translate needs into technical solutions.


• UAT & Quality Assurance: Lead User Acceptance Testing (UAT) to validate solutions against business objectives.


• Mentorship: Provide guidance and mentorship to junior business analysts.

• Experience: 8+ years of experience in Business Analysis, with a minimum of 5 years specifically in the US Healthcare Payer or Provider industry.


• Domain Knowledge: Strong, demonstrated expertise in Value-Based Care (VBC) models, provider contracting, and population health.


• Technical Skills:
  
  
  
  • Proficiency in SQL for data querying and analysis.
  
  
  • Experience with EHR systems (e.g., Epic, Cerner) or Payer platforms (e.g., Facets).
  
  
  • Familiarity with data visualization tools (Tableau, Power BI).
  
  
  • Solid understanding of HIPAA compliance and EDI transactions.
  
  
  
  


• Methodologies: Strong experience working within Agile/Scrum environments using Jira and Confluence.


• Education: Bachelor’s degree in Business Administration, Healthcare Administration, or Information Technology. Master’s degree is a plus.

• Exceptional analytical, problem-solving, and critical thinking skills.


• Strong communication and negotiation skills to influence stakeholders at various levels.


• Ability to work in a dynamic, fast-paced environment.

• Certifications such as Certified Professional in Healthcare Information and Management Systems (CPHIMS) or Certified Business Analysis Professional (CBAP).


• Experience in clinical data aggregation tools.