Business Analyst - Operations

Key Responsibilities

• Elicit, analyze, and document business requirements (BRDs, FRDs, acceptance criteria, process flows).
• Partner with stakeholders to translate business needs into system requirements for PI products (e.g., DRG review, HBA, COB, data mining, IBR).
• Conduct claims data analysis to identify trends, validate audit findings, and support product design.
• Collaborate with IT, QA, and operations teams to ensure requirements are implemented and tested accurately.
• Track and report performance metrics, savings impact, and accuracy rates for PI solutions.

Requirements

• Education: Bachelor’s degree in Business, Healthcare Administration, Data Analytics, or related field (or equivalent experience).
• Experience:
• 3+ years as a Business Analyst in healthcare, payer, or PI environment.
• Strong understanding of claims processing (professional, facility, pharmacy) and related transactions (837, 835, COB, EOBs).
• Experience documenting detailed requirements and acceptance criteria.

Skills

• Strong analytical and problem-solving abilities.
• Proficiency in SQL/Excel; familiarity with BI tools a plus.
• Excellent communication and stakeholder management skills.
• Ability to manage competing priorities and deliver within deadlines.

Prior Experience

• Prior work with DRG auditing, HBA, COB, IBR, or edit engine configuration.
• Knowledge of medical coding standards (ICD, CPT, HCPCS).
• Familiarity with payer SIU/FWA operations or subrogation.
• Exposure to Agile methodologies and tools such as Jira/Confluence.
• Detail-oriented, with the ability to bridge business and technical needs effectively.
• Adept at interpreting claims data and turning insights into actionable requirements.
• Collaborative, clear communicator who thrives in cross-functional environments.
• Driven to reduce waste and improve accuracy in the healthcare ecosystem.