Business Analyst – Healthcare

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. This range is provided by Lumenalta. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

$90,000.00/yr - $/yr

As a Business Analyst – Healthcare, you will play a critical role in shaping digital transformation across the U.S. healthcare landscape. You’ll work closely with clients, delivery managers, and technical teams to translate complex healthcare regulations, payer and provider workflows, and Medicaid/Medicare program requirements into actionable business and functional specifications. Your expertise will ensure that every solution we deliver aligns with compliance standards, improves operational efficiency, and drives better health outcomes for patients and members alike.

• You have a deep understanding of the U.S. healthcare system, particularly Medicaid and Medicare programs, payer operations, and provider networks.
• You excel at bridging the gap between business and technology, translating healthcare policy, data, and process requirements into clear documentation and delivery plans.
• You thrive in environments that require precision, empathy, and regulatory awareness—where the work you do directly impacts the accessibility, affordability, and quality of care.
• You are detail‑oriented, analytical, and proactive—able to identify opportunities for optimization while ensuring compliance with CMS, HIPAA, and state‑specific healthcare regulations.
• You collaborate seamlessly across technical, business, and clinical stakeholders, ensuring every voice is heard and every requirement is well‑defined.

• Requirements Gathering & Analysis:
  Partner with clients and internal teams to understand, document, and validate business needs across Medicaid, Medicare, and payer/provider operations.
• Process Mapping & Optimization:
  Analyze current‑state workflows (e.g., claims processing, eligibility and enrollment, provider data management) and define future‑state solutions.
• Documentation:
  Develop detailed business requirements, functional specifications, and user stories that guide design and delivery teams.
• Regulatory Compliance:
  Ensure all requirements and proposed solutions align with federal and state healthcare regulations, CMS standards, HIPAA, and interoperability mandates.
• Stakeholder
  
  Collaboration:
  
  Facilitate discussions between product delivery, engineering, QA, and client teams, ensuring clarity, alignment, and smooth execution.
• Data & Systems Analysis:
  Work with data teams to validate data flows, mappings, and integration points across systems (EHR, EMR, claims, and analytics platforms).
• Testing Support:
  Collaborate with QA teams to develop test cases and acceptance criteria that validate business requirements and ensure successful user acceptance testing (UAT).
• Change Management:
  Support organizational change efforts by creating clear documentation, process training, and communication materials for end users.
• Continuous Improvement:
  Identify opportunities for efficiency, cost reduction, and improved user experience across healthcare delivery processes.

• 5–10 years of experience as a Business Analyst or Product Analyst in healthcare technology, consulting, or payer/provider organizations.
• Strong understanding of Medicaid and Medicare program operations, payer workflows, and healthcare data systems.
• Experience working with EHR/EMR, claims processing, eligibility & enrollment systems, and data integration projects.
• Proven ability to manage requirements across complex, multi‑stakeholder projects within regulated environments.
• Familiarity with CMS frameworks, HIPAA, and healthcare interoperability standards (e.g., HL7, FHIR).
• Strong analytical, problem‑solving, and communication skills with the ability to translate technical details into business language.
• Experience with Agile or hybrid delivery methodologies and tools such as JIRA, Confluence, or Azure Dev Ops.
• Bachelor’s degree in Business, Healthcare Administration, Information Systems, or a related field.
• Experience interpreting healthcare data structures, including claims, eligibility, and encounter…