Business Analyst, Provider Network (Salesforce Needed) Remote

Our client operates within the managed care and healthcare sector, focusing on provider network management and regulatory compliance. They address challenges related to coverage, reimbursement, and processing functions by developing and maintaining systems solutions aligned with regulatory and health plan requirements.

About the role

The Business Analyst, Provider Network is responsible for accurately interpreting and managing regulatory and functional requirements related to healthcare coverage and reimbursement. This role ensures that system solutions meet compliance standards by coordinating with stakeholders and supporting governance processes. The position plays a key role in maintaining alignment between regulatory updates and health plan operations to support effective financial and operational outcomes.

Responsibilities

• Develop and maintain requirement documents for coverage, reimbursement, and system changes ensuring alignment with regulatory and health plan requirements.
• Monitor regulatory sources to ensure updates are consistent and accurately reflected.
• Lead the development and management of review processes and committee structures with partner organizations.
• Analyze root causes and assist with problem management related to state requirements.
• Communicate requirement interpretations and changes to health plans, product teams, and corporate functional areas for approval and solution traceability.
• Support resolution of requirement interpretation inconsistencies and complaints.
• Report regularly on work efforts and impacts of requirement changes affecting financials.
• Collaborate with operations leadership and plan support functions to review compliance issues for benefit planning.

Requirements

• Minimum of 2 years’ experience in managed care, health insurance, or a related field.
• Knowledge of policy and government legislative review.
• Strong analytical and problem-solving skills.
• Proficiency with Microsoft Office Suite including Word, Excel, Outlook, and Teams.
• Ability to work independently in a remote environment and coordinate across time zones.
• Effective oral and written communication skills.
• Salesforce knowledge; certification is helpful.
• Experience in business operations and managed care provider space.

Skills

• Project implementation experience.
• Familiarity with federal regulatory policies such as CMS and ACA.
• Medical coding certification.