Sr. Business Analyst

About the role

The Business System Analyst (BSA) will support the implementation of UST HealthProof's core-admin ecosystem, focusing on claims adjudication, enrollment, provider, authorization, and payment systems. The role involves working closely with Health Plan Customers, third-party vendors, internal product teams, solution architects, and product owners to define and implement business rules and processes.

Responsibilities

• Lead business requirement conversations with customers and internal teams
• Manage end-to-end requirements involving all stakeholders
• Develop business and functional requirements for claims, enrollment, provider, authorization, and payment systems
• Create solutions for current business processes using UST HealthProof’s core-admin ecosystem
• Negotiate with clients to develop processes that are current and applicable to the situation
• Collaborate with business users, management, IT, and offshore staff to ensure the finished product meets project objectives and client expectations by applying 'Agile-like' project methodology
• Instrumental in analyzing healthcare business requirements and translating them to functional and technical requirements
• Identify opportunities for automation, performance improvements, and reusability
• Create high-level workflow diagrams and system context diagrams
• Document the understanding of the process flow using swim lane diagrams
• Produce the Requirements plan that aligns with the overall Project Implementation plan
• Dictate risks and dependencies in the timely manner with the customer to complete requirement gathering to meet project plan dates
• Conduct requirement walkthroughs with customers and internal/external stakeholders
• Collaborate with the development team and QA team to ensure the finished product meets project objectives and client expectations
• Contribute to sprint planning, retrospectives, go-live/no-go-live evaluations
• Conduct demo of MVPs for the customer

Requirements

• Knowledgeable in Healthcare insurance domain (Medicare, Medicare Advantage, Medicaid, ACA or Commercial)
• Exposure to healthcare ecosystems from partners like HealthEdge, TriZetto, NASCO, Advanture, or Change Healthcare
• 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 analysing business requirements and translating/mapping them to technical requirements in EDI technology by analysing 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
• Experience working HealthEdge applications like HealthRules Payor or GuidingCare is a plus
• Understanding of SQL, XSDs is a plus
• Bachelor’s degree or higher in business or technical field, 10+ years of relevant work experience in business analysis

Qualifications

• Remote, US-based position
• Full-time, permanent employment
• Up to 25% travel
• Exempt status under FLSA
• Hybrid or remote work environment
• Long periods of time sitting and/or standing in front of a computer using video technology

Benefits

UST HealthProof offers competitive benefits, including:

• HealthEdge is an equal opportunity employer
• We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us
• The annual US base salary range for this position is $120,000 to $140,000