Note: The job is a remote job and is open to candidates in USA. HealthEdge is hiring a Senior Business Systems Analyst to capture business requirements for health plan customers implementing its core-admin ecosystem. The role works with customers and internal and external teams to define business rules and processes, translate healthcare requirements into functional and technical requirements, and support implementation delivery.
Responsibilities
- Leading business requirement conversations with customer and internal teams
- Managing the end-to-end requirements involving all the stakeholders
- Responsible for developing business and functional requirements for Claims, Enrollment, Provider, Authorization, Payment systems
- Create solutions for current business processes using HealthEdge’s core-admin ecosystem
- Negotiate with client to develop processes that are current and applicable to the situation
- Collaborate with business users, management, IT, and offshore staff to ensure the finish product meets project objectives and client expectations by applying ‘Agile like’ project methodology
- Instrumental in analyzing the healthcare business requirements and translating them to functional and technical requirements
- Identify opportunities for automation, performance improvements, reusability
- Develop high level workflow diagrams and system context diagrams
- Document the understanding of the process flow using swim lanes diagrams
- Produce the Requirements plan that aligns with the overall Project Implementation plan
- Dictate the risks and dependencies in the timely manner with the Customer to complete the requirement gathering to meet up with the project plan dates
- Must work with Offshore Business Analysts to elaborate user stories
- Conduct Requirement walk through with the customer and internal/external stakeholders
- Collaborate with the development team & QA team to ensure the finish product meets project objectives and client expectations
- Contribute towards sprint planning, retrospective, go-live/no go-live evaluation meetings
- Conduct Demo of MVPs for the customer
Skills
- The Candidate should possess deep knowledge & experience in healthcare payer domains (Claims adjudication, Enrollment, Provider, Payment)
- He / She should have excellent requirement elicitation and communication skills and ability to engage as part of a team working both physically and virtually
- Also, he / she should be able to identify the customer problems and work with Solution Architect(s) to provide the solution to customer
- Knowledge of the healthcare insurance domain (Medicare, Medicare Advantage, Medicaid, ACA or Commercial)
- Experience with mapping of EDI healthcare transactions (837, 834, 835,270/271, 276/277, 278)
- Awareness to Agile tools and scrum methodologies
- Communication skills with peers, customers, and partners including the ability to convey information effectively
- Experience in analyzing the business requirements and translating/mapping them to technical requirements in EDI technology by analyzing implementation/companion/TR3 guides
- Experience documenting requirements or user stories and communicating the requirements to technical teams, partners/vendors or product teams
- Experience working in an onshore/offshore model is a must
- Bachelor's degree or higher in business or technical field, 10+ years of relevant work experience in business analysis
- Exposure to healthcare eco-systems from partners like HealthEdge, TriZetto , NASCO, Advantasure or Change Healthcare
- Experience working HealthEdge applications like HealthRules Payer (HRP) or GuidingCare is a plus
- Understanding of SQL, XSDs is a plus
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