Business Analyst-Healthcare Payer - Hyderabad - ValueMomentum

    ValueMomentum
    ValueMomentum Hyderabad

    17 hours ago

    Technology / Internet
    Description

    Job Description

    We are seeking an experienced Business Analyst with extensive expertise in the Healthcare Payer domain to join our team as an SME.

    Responsibilities

    • Act as a trusted SME for Healthcare Payer processes, policies, regulations, and industry best practices
    • Elicit and analyze complex business requirements from cross-functional stakeholders, including payers, providers, and other entities
    • Define/Write the functional specifications, process flows, and use cases to guide solution design and delivery
    • Collaborate with IT, QA, and business teams to align on project scope, objectives, and deliverables
    • Perform gap analyses to pinpoint areas for process optimization and system enhancements
    • Participate in workshops and stakeholder meetings to gather insights, validate requirements, and drive alignment
    • Translate intricate business processes into clear, actionable technical documentation that can be used by developers
    • Provide expert guidance during solution implementation to ensure compliance and alignment with business goals.
    • Support stakeholders through training and change management initiatives

    Requirements

    • Bachelor's degree in Science, or a related field
    • Minimum of 5 years of experience within the Healthcare Payer domain
    • Deep understanding of payer operations including claims processing, enrolment, member management, provider networks, and benefit administration
    • Knowledge of the Business Process, Good Understanding of EDI
    • Strong understanding of healthcare data formats, standards, and can map them to CMS and state level reporting needs.
    • Knowledge of healthcare regulations and compliance standards (e.g., HIPAA, CMS, ACA)
    • Expertise with payer systems such as claims management, enrolment platforms, billing, and provider portals
    • Exceptional communication and stakeholder engagement skills, Written and Spoke communication Skills
    • Familiarity with Agile and Scrum methodologies
    • Proficiency with Business Analysis tools and techniques

    Nice to have

    • Certified Business Analysis Professional (CBAP)
    • Healthcare-specific certifications such as CHC or CPCO

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