Senior Business Analyst

Senior Business Analyst

Product Development Job Roles Responsibilities

1. Be the Operational Truth Source for the Platform. You will be accountable for validating that platform outputs make sense in the real world. This includes:

• Reviewing payer contracts, amendments, and fee schedules
• Interpreting real-world contract logic (lesser-of, modifiers, MCO products, effective dates)
• Reading raw 835 remits and identifying: Reimbursement issues vs legitimate adjustments; Payer miss configuration vs provider error; Systemic vs one-off issues
• Calling out false positives and explaining why something is not a true issue. If something looks technically correct but operationally wrong, you are expected to stop it.

1. Own Synthetic Data Realism (Critical). The platform will initially rely on synthetic data for development and validation. You will:

• Define what realistic synthetic data looks like: payer mix, CARC/RARC distributions, modifier usage patterns, underpayment frequency and dollar impact
• Review synthetic data sets and flag unrealistic assumptions
• Guide engineers and vendors on correcting synthetic data generation logic. This role protects the credibility of everything we build.

1. Be Deeply Embedded in Testing Validation. You will be hands-on in:

• Reviewing detection outputs and classifying true vs false positives
• Validating confidence scores against operational reality
• Helping define suggested next step classifications (appeal, rebill, review, do not pursue)
• Testing against real customer data during pilot phases. Your feedback will directly shape detection logic, confidence thresholds, and future AI agent behavior. You are effectively the human-in-the-loop backbone of the system.

1. Act as the RCM Counterweight in Vendor Engagements. You will actively participate in vendor evaluations, technical reviews, and edge-case discussions. You will:

• Ask uncomfortable but necessary questions
• Spot hand-wavy answers around contracts or EDI
• Distinguish between can build, has built, and is guessing
• This role is critical to holding vendors accountable and ensuring delivery meets operational standards.

1. Help Carry the Long-Term Platform Vision Forward. While the MVP starts with underpayments, the platform is designed to evolve toward:

• Broader reimbursement correctness (denials, old AR, charge capture)
• Recommendation intelligence and outcome monitoring
• Selective automation with AI agents
• Contract renegotiation insights. You will help ensure core data models are reusable, intelligence is generalized, and we t hard-code short term assumptions that block long-term evolution.

Candidate Requirements

Experience Domain Expertise

• 6-10+ years in health care RCM revenue integrity, payer contracts, payment analysis, denials, or A/R
• Experience working with ambiguous or conflicting data
• Deep knowledge of payer contracts and fee schedules percent of Medicare, lesser-of, MCO products, modifier rules, effective dates
• Deep knowledge of the RCM data ecosystem claims, remittances, fee schedules, industry benchmarks, regulatory references, and how they connect
• Deep expertise in at least one RCM process area (appeals, denials, A/R follow-up, payment posting) you ll help design how AI agents execute these work flows

Judgment Mindset

• Strong judgment in gray areas where contracts, data, and payer behavior don t line up
• Willingness to challenge assumptions including those from engineers and vendors
• Comfortable saying this would never happen in production
• Builder mentality: you like shaping systems, not just running reports
• Technical Comfort (Not a Data Scientist)

Technical Comfort (Not a Data Scientist)

• SQL proficiency ability to query data, validate outputs, build test cases
• Advanced Excel pivot tables, VLOOKUP/INDEX-MATCH, large data set manipulation
• Comfortable working with raw data (CSV, JSON, EDI extracts)
• Able to explain domain logic clearly to engineers you t need to code, but you must understand how logic translates into systems

Preferred (Nice to Have)

• Experience with lab billing (CLFS) or physician billing (PFS) ideally both
• Background in underpayment recovery, contract audits, or payer disputes
• Familiarity with Medicare fee schedules and locality adjustments (GPCI)
• Experience with data warehouses (Snowflake, Redshift, BigQuery)
• Prior experience in a startup or product development environment

Job Category: Product Development

Job Type: Full Time

Job Location: Pune IN

Disclaimer : This job posting has been aggregated from external source. Role details, content, and availability are subject to change. Applicants are advised to confirm the latest information directly on the company website before applying.