Business Analyst - US Healthcare

Job Title: Business Analyst US Healthcare Adjudication System

Job Summary:

We are seeking a highly skilled and experienced Business Analyst to join our team, specializing in US Healthcare Adjudication Systems. The ideal candidate will have in-depth knowledge of healthcare claims processing, adjudication workflows, and payer-provider interactions. This role requires strong analytical skills, domain expertise, and the ability to bridge the gap between business needs and technical solutions.

Key Responsibilities:

• Analyze and document business processes related to healthcare claims adjudication, ensuring compliance with industry standards (HIPAA, ACA, CMS regulations, etc.).

• Gather and define business requirements, functional specifications, and use cases for adjudication system enhancements.

• Collaborate with cross-functional teams, including IT, developers, QA, and stakeholders, to implement and optimize healthcare claims processing solutions.

• Evaluate system capabilities and recommend improvements to enhance automation, accuracy, and efficiency in claims adjudication.

• Perform data analysis on claims processing to identify discrepancies, trends, and opportunities for process optimization.

• Support system testing, UAT (User Acceptance Testing), and post-implementation validation to ensure accurate and efficient claim adjudication.

• Develop documentation, including business process workflows, training materials, and operational guidelines.

• Act as a liaison between business users and technical teams to ensure clarity and alignment on project goals and deliverables.

• Stay updated with industry trends, regulations, and compliance requirements affecting healthcare claims adjudication.

Required Qualifications:

• Bachelors degree in Business, Healthcare Administration, Information Systems, or a related field.

• 8+ years of experience as a Business Analyst in the US Healthcare domain, specifically in claims adjudication.

• Strong understanding of healthcare claim life cycle, EDI transactions (837, 835, 270/271, 276/277), and CMS regulations.

• Experience working with adjudication platforms such as Facets, Qicklink, QNXT, Health Edge, or similar systems.

• Proficiency in SQL for data analysis and reporting.

• Excellent analytical, problem-solving, and communication skills.

• Ability to work independently and collaboratively in a fast-paced environment.

• Knowledge of Agile methodologies and experience working in Agile environments