Senior Business Analyst with Healthcare RCM Process

About the Role

Senior Business Analyst

Key Responsibilities

• Discovery & Requirements

• Lead discovery workshops, stakeholder interviews, and process reviews to elicit business and functional requirements.
• Translate business needs into

  BRDs, FRDs, user stories, acceptance criteria

  , and process documentation (BPMN/SIPOC/RACI).

• Process Excellence

• Map

  as-is

  workflows and design

  to-be

  processes to reduce cycle time, errors, and rework; identify automation opportunities (RPA/AI/ML where applicable).
• Define and track

  KPIs/OKRs

  (e.g., first-pass resolution, denial rate, days in A/R, turnaround time, encounter closure rate).

• Healthcare Domain Leadership

• Apply regulatory and standards knowledge (e.g.,

  HIPAA

  ,

  HITECH

  ,

  CMS

  guidelines;

  ICD-10/CPT/HCPCS

  coding;

  HL7/FHIR

  for integrations).
• Drive outcomes in one or more domains:

• Payer:

  Claims adjudication, prior authorization/UM, care management, provider data management, EDI (X12 270/271/276/277/835/837), risk adjustment, STARS/HEDIS.

• Provider/Health System:

  Revenue Cycle Management (RCM)

  , scheduling & referrals, charge capture, billing & collections, denial management, clinical documentation, care coordination.

• Health-Tech/SaaS:

  Product discovery, interoperability, data pipelines, customer onboarding, compliance-by-design.

• Delivery & Change Management

• Work in

  Agile/Scrum

  (or hybrid), owning backlog, sprint goals, and prioritization with product owners.
• Coordinate

  UAT

  , traceability (RTM), release readiness, and adoption (training, comms, SOP updates).

• Stakeholder Management

• Communicate clearly with clinical leaders, revenue cycle leaders, payers, compliance, engineering, data teams, and vendors.
• Build business cases and ROI models for process improvements and technology investments.

Required Qualifications

• 6–10+ years

  as a Business Analyst or Process Consultant with

  4+ years in healthcare

  (payer, provider, PBM, or health-tech).
• Proven experience in

  process mapping & optimization

  , requirements management, and

  Agile delivery

  .
• Hands-on with:

  Jira/Azure DevOps

  ,

  Confluence

  ,

  Visio/Miro/Lucidchart

  ,

  SQL (intermediate)

  for data validation,

  Excel/Sheets

  for analysis.
• Familiarity with

  EHR/Practice Management

  systems (e.g.,

  Epic, Cerner/Oracle Health, Meditech, Athena

  , or similar) and/or

  payer core systems

  (Facets, QNXT, HealthRules, TriZetto, or similar).
• Working knowledge of

  HIPAA

  ,

  HL7/FHIR

  ,

  EDI X12

  , and medical coding (

  ICD-10, CPT, HCPCS

  ).
• Strong communication, stakeholder facilitation, and documentation skills.