Business Analyst - Healthcare (Payor)
- Zensar
- 8 - 13 years
- Hyderabad
- 2 months ago
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Job Description
Business Analyst Healthcare (Payer Domain)
Experience: 5 8 Years
Location: Pune/Bengaluru
Domain: Healthcare Payer, RCM, Underwriting
Location: Pune/Bengaluru
Domain: Healthcare Payer, RCM, Underwriting
- Bachelor s degree in healthcare, Life Sciences, Engineering, Pharmacy, or related fields.
- Preferred certifications: AHIP, CBAP, CPC, PMP, Lean Six Sigma, or similar.
- 5 8 years of experience as a Business Analyst in healthcare Payor systems.
Key Responsibilities
- Gather, analyze, and document business requirements across claims, enrollment, eligibility, membership, provider management, benefits, and authorization workflows in the Payor domain.
- Support enhancements in claims adjudication, including rules configuration, benefits validation, COB, pricing, and EOB generation.
- Work on member and provider enrollment, eligibility verification, and EDI transactions (837, 834, 270/271, 835, 276/277).
- Assist in health plan benefits configuration including coverage rules, utilization management rules, cost sharing, and prior authorization requirements.
- Contribute to premium billing, payment posting, revenue reconciliation, and other Payor ficial workflows.
- Support provider contracting, credentialing, fee schedule management, and reimbursement methodologies (FFS, capitation, bundled payments).
- Ensure alignment with HIPAA, CMS, NCQA regulatory and Payor compliance requirements.
- Perform gap analysis, define current vs. future state processes, and propose system/process improvements.
- Create BRDs, FRDs, User Stories, Use Cases, and workflow diagrams for business and technical teams.
- Improve Revenue Cycle Management (RCM) processes including patient access to AR collections, payment posting, denials management, and AR reduction.
- Analyze root causes for claim denials, improve clean claim rates, and support appeals/reprocessing.
- Support underwriting activities such as risk assessment, analyzing utilization trends, claims data analysis, and assisting in premium pricing models.
- Collaborate with actuarial/product teams on group/individual plan pricing and renewals.
- Perform data validation using SQL/Excel and work with engineering teams on integrations, data mapping, and API workflows.
- Lead and support UAT, including test plan creation, test execution, and defect tracking.
- Work closely with cross functional business, product, and engineering teams in Agile environments.
Required Skills
- Strong experience in the Healthcare Payor domain (mandatory).
- Hands on experience in:
- Claims Processing & Adjudication
- Enrollment & Eligibility
- Benefits Administration
- Provider Network Management
- Revenue Cycle Management
- Underwriting fundamentals
- Medical coding basics (ICD, CPT, HCPCS)
- EDI transactions (837/835/834/270/271/276/277)
- Strong requirement gathering, process mapping, and documentation skills.
- Ability to write detailed user stories, acceptance criteria, and functional specifications.
- Strong analytical ability with SQL/Excel/reporting tools.
- Understanding of HIPAA, CMS guidelines, Payor compliance, and regulatory frameworks.
- Experience supporting UAT and working in Agile/Scrum environments.
- Excellent communication and stakeholder management skills.
Job Classification
Industry: IT Services & ConsultingFunctional Area / Department: Data Science & AnalyticsRole Category: Business Intelligence & AnalyticsRole: Business AnalystEmployement Type: Full timeContact Details:
Company: ZensarLocation(s): Hyderabad+ View Contact
Keyskills: Data analysis Business Analyst Medical coding Underwriting Reconciliation Billing Healthcare Life sciences SQL
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