Note: The job is a remote job and is open to candidates in USA. Resource Logistics Inc. is seeking a Business / Regulatory Analyst to support state-mandated regulatory and compliance initiatives across Medicaid and healthcare payer operations. The role translates regulatory requirements into traceable business and system requirements and supports implementation readiness, backlog remediation, testing, validation, and audit readiness.
Responsibilities
- Analyze and interpret state-specific Medicaid regulations, CMS guidance, mandates, bulletins, and health-plan requirements
- Assess regulatory impacts across business processes, applications, data, integrations, operational workflows, and reporting
- Partner with compliance, legal, product, and business stakeholders to clarify regulatory intent and implementation expectations
- Develop regulatory impact assessments and implementation recommendations
- Elicit, document, and manage business, functional, system, integration, and data requirements
- Create and maintain:
- Business Requirement Documents (BRDs)
- Functional Requirement Documents (FRDs)
- User Stories and Acceptance Criteria
- Business Rules Documentation
- Process Flows and Use Cases
- Requirements Traceability Matrix (RTM)
- Ensure end-to-end traceability from regulatory mandate through development, testing, deployment, and audit validation
- Traceability management
- Support initiatives involving:
- Claims processing and adjudication
- Member eligibility and enrollment
- Prior authorization
- Provider data and network administration
- Regulatory reporting
- EDI and file exchanges
- Healthcare integrations and APIs
- Health-plan-specific compliance enhancements
- Manage backlog remediation and technical debt items related to prior regulatory releases
- Collaborate with:
- Business stakeholders
- Compliance and regulatory teams
- Product Owners
- Solution Architects
- Application Development Teams
- Data and Integration Teams
- Quality Engineering Teams
- Release and Production Support Teams
- Facilitate stakeholder workshops, JAD sessions, requirement reviews, and solution validation discussions
- Partner with QA teams to define regulatory test scenarios and validation strategies
- Review and validate SIT, UAT, and regression testing results
- Ensure delivered solutions satisfy regulatory, operational, and audit requirements
- Support defect triage, root cause analysis, and remediation activities
- Maintain complete audit trails and regulatory documentation
- Support compliance reviews, internal audits, regulatory examinations, and implementation evidence collection
- Track requirement changes and ensure alignment with approved regulatory interpretations
Skills
- Bachelor's degree in business, Healthcare Administration, Information Systems, Public Policy, or related field
- 12+ years of Business Analyst or Regulatory Analyst experience
- 10+ years of healthcare payer experience
- Experience supporting Medicaid, Medicare, or Commercial health-plan regulatory initiatives
- Strong understanding of: • Claims lifecycle • Eligibility and enrollment • Provider management • EDI transactions (834, 837, 835, 270/271) • Healthcare data flows and integrations
- Experience creating BRDs, FRDs, User Stories, Process Flows, and RTMs
- Strong stakeholder management and facilitation skills
- Experience working within Agile and/or SAFe environments
- Experience with Medicaid regional/state regulatory implementation programs
- Knowledge of CMS regulations, MMIS, Medicaid managed care operations, and state-specific mandates
- Experience with Facets, QNXT, HealthRules, or similar core payer platforms
- Familiarity with: • Azure DevOps • Jira • Confluence • SQL • Visio • Data mapping and integration specifications
- Experience supporting regulatory audits and compliance reviews
- Medicaid Regulatory Programs • Claims Adjudication • Member Eligibility & Enrollment • Provider Data • Payment Integrity • Prior Authorization • Regulatory Reporting • Healthcare Data Exchange • API & EDI Integrations • State-Specific Compliance Requirements • CMS and Healthcare Regulatory Compliance
Benefits
- Remote work
Company Overview
Company H1B Sponsorship