Business Analyst - US Healthcare (Reference)

Your role in our mission

• Analyze, design, and document business requirements related to healthcare claims, reference data, and code sets
• Work with stakeholders to gather and define requirements involving ICD, CPT, HCPCS, UB04, revenue codes, provider taxonomy, and other healthcare reference data
• Develop and maintain business analysis artifacts such as BRDs, functional specifications, process flows,decision tables, and traceability matrices
• Translate business, policy, and coding requirements into clear functional objectives for technical teams
• Perform impact analysis for codeset changes, regulatory updates, and policy changes across claims processing systems
• Support testing activities, including defining test scenarios and validating system outputs
• Participate in technical reviews and project discussions to ensure requirement alignment across lifecycle phases
• Identify opportunities for business process improvement and data governance enhancements
• Collaborate with developers, testers, and stakeholders for issue resolution, defect triage, and rootcause analysis
• Communicate effectively with business and technical teams through documentation, meetings, and presentations

What we're looking for

• 6 - 10 years of relevant experience in a Business Analyst role
• Strong experience in healthcare domain (Medicaid / Medicare / claims processing)
• Working knowledge of healthcare code sets, including: ICD10CM / ICD10PCS , CPT, HCPCS , UB04 institutional billing elements
• Revenue codes, modifiers, type of bill, place of service
• Experience in requirements gathering, analysis, and documentation
• Strong understanding of claims lifecycle, adjudication, and reference data workflows
• Experience working with SDLC processes, testing, and system configuration concepts
• Strong analytical and problemsolving skills
• Proficiency in Microsoft Excel and data analysis tools
• Strong communication and stakeholder management skills

Preferred Skills:

• Experience with MMIS systems or healthcare program implementations
• Knowledge of HIPAA transactions and X12 claims (837, 835, etc.)
• Experience with SQL for data analysis and validation
• Familiarity with ALM tools, Jira, ServiceNow, or similar platforms
• Experience with data governance, referencedata management, or claims edits/billing rules