Senior Healthcare Business Analyst / Behavioral Health SME

About the role

Role Overview Seeking a seasoned Behavioral Health SME with strong Business Analyst and healthcare systems expertise to support payer transformation initiatives. The ideal candidate will have deep knowledge of Behavioral Health operations, end-to-end payer processes, and healthcare regulations, along with the ability to bridge business and technology teams.

Requirements

• 10+ years of Healthcare Payer experience with 5+ years in Behavioral Health (Mental Health & Substance Use Disorders)
• Strong understanding of the end-to-end payer lifecycle : Eligibility & Enrollment Benefits Configuration Claims Processing & Adjudication Prior Authorization Care & Case Management Provider Management Appeals & Grievances Payment Integrity
• Deep knowledge of Behavioral Health regulations , including: MHPAEA (Mental Health Parity) Medicare & Medicaid BH programs HIPAA CMS and State-specific regulatory requirements NCQA/URAC standards
• Strong Business Analysis skills: Requirements gathering BRD/FRD/User Stories Process mapping Gap analysis UAT/SIT support Stakeholder management
• Experience with payer platforms such as Facets, QNXT, HealthRules, GuidingCare, TruCare, or similar .
• Knowledge of healthcare transactions and interoperability standards: 837, 835, 834, 270/271 HL7/FHIR
• Strong SQL, data analysis, and system integration understanding.

Qualifications

• Preferred Experience with Commercial, Medicare, and Medicaid lines of business.
• Exposure to Behavioral Health care management, utilization management, and value-based care programs.
• Experience working on payer modernization, data, AI , or digital transformation initiatives.
• Ideal Candidate The ideal candidate will be a Behavioral Health payer SME who combines deep business process knowledge, regulatory expertise, system knowledge, and business analysis skills, with proven experience across: Behavioral Health + Claims + Eligibility + Benefits + Care Management + Provider Operations + Regulatory Compliance + Payer Technology Platforms. This person should be capable of driving both strategic business discussions and detailed system-level solution design discussions with equal effectiveness.