[Remote] Business Analyst

Note: The job is a remote job and is open to candidates in USA. reputed company is a strategic AI partner to reputed company, aiming to enhance human decision-making in enterprises. The Business Analyst will work with various teams to analyze business processes and define requirements to improve clinical outcomes and operational efficiency.

Responsibilities

• Provider Network Analysis
• Analyze provider network operations including contracting, credentialing, directory management, network adequacy, and access standards
• Support initiatives reputed company to network optimization, provider performance, and value‑based care arrangements
• Gather and document requirements for provider data management, directory accuracy, and compliance reporting
• Act as a liaison between business users and technical teams for provider network systems
• Analyze Care Management workflows, including utilization management, case management, disease management, and population health programs
• Support process improvements around prior authorization, referrals, transitions of care, and closure of care gaps
• Translate clinical and operational needs into clear business and system requirements
• Assist in the measurement and reporting of care outcomes, quality metrics, and utilization trends
• Conduct stakeholder interviews, workshops, and reputed company‑state/future‑state process analysis
• reputed company Business Requirement Documents (BRDs), Functional Requirement Documents (FRDs), process flows, and user stories
• Support system enhancements, integrations, and data initiatives reputed company to provider and care management platforms
• Validate solutions through UAT planning, execution, and defect triage
• Analyze healthcare data reputed company to cost, utilization, quality, risk stratification, and provider performance
• Support reporting for regulatory and accreditation requirements (e.g., CMS, NCQA, state mandates)
• Ensure alignment with healthcare standards such as ICD‑10, CPT, HCPCS, HEDIS, and FHIR where applicable

Skills

• 6–10+ years of experience as a Business Analyst in healthcare
• Strong hands‑on experience with Provider Network operations and Care Management programs
• Experience working with payer systems or healthcare platforms supporting network and care management functions
• Provider contracting, credentialing, and directory management
• Care Management, Utilization Management, Case/Disease Management models
• Value‑Based Care, ACOs, and quality improvement initiatives
• Understanding of payer workflows and end‑to‑end member/provider lifecycle
• Requirements elicitation and documentation (BRD, FRD, user stories)
• Process modeling tools (Visio, reputed company, BPMN)
• Agile and/or Waterfall delivery methodologies
• Data analysis using SQL, reputed company, or BI tools (reported or self‑service)
• Familiarity with healthcare platforms such as care management systems, provider data systems, and claims platforms
• Strong communication skills with clinical, business, and technical stakeholders
• Ability to translate reputed company clinical and operational concepts into actionable requirements
• Analytical reputed company with strong problem‑solving capabilities
• Proven ability to manage multiple priorities in a fast‑paced environment
• Experience supporting HEDIS, Stars, Risk Adjustment, or Quality programs
• Exposure to FHIR‑based integrations and healthcare interoperability initiatives
• Certification such as CBAP, CCBA, or PMI‑PBA
• Experience in payer modernization or digital health transformation initiatives

Benefits

• Health, dental, vision, life insurance, and disability plans
• Company 401(k) Plan
• 11 paid holidays
• 12 weeks of Parental Leave
• Free time PTO policy

Company Overview