Lead Business Analyst
Innova Solutions, New York, NY, United States
We are seeking an experienced
Healthcare Lead Business Analyst
with strong
payer?side
expertise and
payments/financial processing
experience. The role will involve leading business analysis activities across claims, benefits, enrollment, and payment lifecycle initiatives, while working closely with business stakeholders, product owners, and technology teams to deliver compliant and scalable healthcare solutions.
Key Responsibilities
Lead
business analysis efforts
for payer?side healthcare systems including
claims, enrollment, benefits, provider, and payments .
Work extensively on
claims processing and adjudication , including medical, dental, hospital, and pharmacy claims.
Support initiatives related to
payments , including claims payments, adjustments, denials, remittances (EOB/EOP), provider payments, and reconciliation.
Elicit, analyze, document, and validate
business and system requirements
from internal and external stakeholders.
Translate business needs into
functional requirements, user stories, BRDs, and FRS documents .
Collaborate closely with
technical teams
to ensure accurate implementation of requirements.
Perform
gap analysis , impact analysis, and support solution design decisions.
Ensure compliance with
US healthcare regulations
(HIPAA, CMS, ACA) and payer operational guidelines.
Participate in
Agile/Scrum and Waterfall
delivery models; support sprint planning, grooming, UAT, and production release activities.
Mentor junior business analysts and establish BA best practices.
Required Skills & Experience
10+ years of experience as a
Business Analyst in US Healthcare , with strong
payer?side exposure .
Deep understanding of
healthcare claims adjudication , claim edits, pricing, and audit processes.
Strong experience with
healthcare payments , including claims payments, provider reimbursement, adjustments, reversals, and financial reconciliation.
Knowledge of
Revenue Cycle Management , including:
Benefit plans
Member eligibility
Provider data
Claims operations
Financial workflows
Working knowledge of
medical coding systems
(CPT, HCPCS, ICD, DRG, Revenue Codes, Modifiers).
Experience with
Medicaid (MMIS)
and/or
commercial payer systems
is highly preferred.
Exposure to
EDI transactions (837, 835, 834)
Strong documentation and communication skills; ability to interact with business, technical, and executive stakeholders.
Hands?on experience with
Agile tools
(JIRA, Confluence) and requirement management processes.
Preferred Qualifications
Experience working with
State Medicaid or Medicare programs
Prior experience leading large?scale payer transformation or modernization initiatives
Healthcare Lead Business Analyst
with strong
payer?side
expertise and
payments/financial processing
experience. The role will involve leading business analysis activities across claims, benefits, enrollment, and payment lifecycle initiatives, while working closely with business stakeholders, product owners, and technology teams to deliver compliant and scalable healthcare solutions.
Key Responsibilities
Lead
business analysis efforts
for payer?side healthcare systems including
claims, enrollment, benefits, provider, and payments .
Work extensively on
claims processing and adjudication , including medical, dental, hospital, and pharmacy claims.
Support initiatives related to
payments , including claims payments, adjustments, denials, remittances (EOB/EOP), provider payments, and reconciliation.
Elicit, analyze, document, and validate
business and system requirements
from internal and external stakeholders.
Translate business needs into
functional requirements, user stories, BRDs, and FRS documents .
Collaborate closely with
technical teams
to ensure accurate implementation of requirements.
Perform
gap analysis , impact analysis, and support solution design decisions.
Ensure compliance with
US healthcare regulations
(HIPAA, CMS, ACA) and payer operational guidelines.
Participate in
Agile/Scrum and Waterfall
delivery models; support sprint planning, grooming, UAT, and production release activities.
Mentor junior business analysts and establish BA best practices.
Required Skills & Experience
10+ years of experience as a
Business Analyst in US Healthcare , with strong
payer?side exposure .
Deep understanding of
healthcare claims adjudication , claim edits, pricing, and audit processes.
Strong experience with
healthcare payments , including claims payments, provider reimbursement, adjustments, reversals, and financial reconciliation.
Knowledge of
Revenue Cycle Management , including:
Benefit plans
Member eligibility
Provider data
Claims operations
Financial workflows
Working knowledge of
medical coding systems
(CPT, HCPCS, ICD, DRG, Revenue Codes, Modifiers).
Experience with
Medicaid (MMIS)
and/or
commercial payer systems
is highly preferred.
Exposure to
EDI transactions (837, 835, 834)
Strong documentation and communication skills; ability to interact with business, technical, and executive stakeholders.
Hands?on experience with
Agile tools
(JIRA, Confluence) and requirement management processes.
Preferred Qualifications
Experience working with
State Medicaid or Medicare programs
Prior experience leading large?scale payer transformation or modernization initiatives