Business Analyst Lead

We are looking for a Healthcare Business Analyst with strong experience in Revenue Cycle Management (RCM), healthcare data standards, and platform implementation. The role involves working in a system integration (SI) model, implementing a third-party healthcare platform for clients, and collaborating across multiple stakeholders. Key Responsibilities 1. Healthcare Domain Expertise

• Work across healthcare domains including:
• Revenue Cycle Management (RCM)
• Prior Authorization
• Care Management
• Value-Based Care
• Population Health
• Quality Reporting
• Translate business workflows into system requirements aligned with industry practices. 2. Data Standards & Interoperability
• Work with healthcare data standards such as:
• EDI X12 transactions (837, 835, 270/271)
• HL7 and FHIR resources
• Perform
• Data mapping and validation
• Requirement documentation and functional specifications
• Data quality checks and issue resolution 3. Platform Implementation (SI Model)
• Lead and support implementation of third-party vendor platforms at customer sites.
• Configure and deploy solutions based on client requirements.
• Collaborate with vendors to align platform capabilities with business needs.
• Understand differences between product development and client-specific implementation. 4. Requirements Management (End-to-End)
• Gather business requirements through stakeholder discussions and workshops.
• Create BRDs, FRDs, and maintain requirement traceability.
• Stay involved through
• Design
• Development
• Testing and UAT
• Manage changing requirements and assess impact on scope and timelines. 5. Solution Design (OOB vs Customization)
• Evaluate and recommend:
• Out-of-the-box (OOB) configurations
• Customizations when necessary
• Provide guidance on platform limitations and suggest alternate solutions.
• Balance business needs with system capabilities and delivery timelines. 6. Healthcare Coding & Financial Concepts
• Apply knowledge of:
• ICD-10, CPT, HCPCS coding systems
• LOINC, SNOMED clinical standards
• CARC/RARC for denial management
• Revenue codes and billing structures
• Use these standards in requirements, validation, and issue analysis. 7. Compliance & Regulatory Understanding
• Ensure adherence to:
• HIPAA guidelines for PHI protection
• CMS billing and compliance rules
• Apply compliance principles in
• Data handling
• Storage, access, and transmission
• System design and reporting 8. Stakeholder & Vendor Management
• Coordinate between:
• Internal delivery teams
• Platform vendors
• Customer stakeholders
• Manage conflicting priorities and ensure alignment.
• Drive effective communication and resolution of issues. 9. UAT & Business Validation
• Design and execute business-driven UAT scenarios for:
• RCM workflows
• Clinical and financial processes
• Work with stakeholders (e.g., billing managers, operations teams) for:
• Validation
• Feedback incorporation
• Final sign-off 10. SQL & Data Validation
• Read, analyze, and validate SQL queries.
• Perform data validation across systems and pipelines.
• Identify and resolve data discrepancies and logic issues.