Business Analyst - Healthcare Reference
Remote
Job Summary
Business Analyst for Healthcare Reference data and claims processing at Gainwell. Analyze, design, and document requirements related to healthcare claims, reference data, and code sets (ICD-10-CM/PCS, CPT, HCPCS, UB-04, revenue codes). Create BRDs, functional specifications, process flows, decision tables, and traceability matrices; translate business, policy, and coding requirements for technical teams; perform impact analysis for code-set changes, regulatory updates, and policy changes; support testing and define test scenarios; participate in reviews; identify opportunities for data governance enhancements; collaborate with developers, testers, and stakeholders; communicate through documentation, meetings, and presentations. Remote work environment with IST shift (2 pm - 11 pm IST).
Required Qualifications
- 6–10 years of experience in a Business Analyst role
- Strong experience in healthcare domain (Medicaid / Medicare / claims processing)
- Working knowledge of healthcare code sets, including ICD-10-CM / ICD-10-PCS, CPT, HCPCS, UB-04 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 with SDLC processes, testing, and system configuration concepts
- Strong analytical and problem-solving skills
- Proficiency in Microsoft Excel and data analysis tools
- Strong communication and stakeholder management skills
- Preferred Skills: MMIS systems, HIPAA transactions and X12 (837, 835), SQL, ALM tools (Jira, ServiceNow), data governance/reference-data management, healthcare audits
- Healthcare coding knowledge or certifications in BA or coding
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