Job Title: Business Analyst
Location: Remote
Duration: 6 Months + Extension
Bill Rate: $120,000-$140,000
Job Type: W-2 Contract
Client: To Be Discussed Later
Work Authorization: US-Citizen, H-1B, OPT-EAD, GC-EAD
Job Duties:
Strong experience in healthcare payer operations and business analysis.
Deep understanding of healthcare payer functions, including:
o Enrollment and Eligibility
o Claims Processing and Adjudication
o Provider Network and Contract Management
o Utilization Management
o Care Management
o Customer Service Operations
o Payment Integrity
o Appeals and Grievances
Experience gathering and documenting business and functional requirements.
Strong analytical, communication, facilitation, and stakeholder management skills.
Experience working in Agile and Waterfall delivery environments.
Preferred Qualifications
Experience with Medicare, Medicaid, Commercial, and Dual-Eligible healthcare programs.
Knowledge of healthcare standards such as FHIR, HL7, EDI X12, HEDIS, STAR Ratings, and CMS regulations.
Experience supporting payer modernization, digital transformation, data management, analytics, or AI-enabled initiatives.
Familiarity with healthcare platforms such as Facets, QNXT, HealthRules, Epic, or related payer.
Equal Opportunity Employer: We are an equal opportunity employer. All aspects of employment including the decision to hire, promote, discipline, or discharge, will be based on merit, competence, performance, and business needs. We do not discriminate on the basis of race, color, religion, marital status, age, national origin, ancestry, physical or mental disability, medical condition, pregnancy, genetic information, gender, sexual orientation, gender identity or expression, national origin, citizenship/ immigration status, veteran status, or any other status protected under federal, state, or local law.