Business Analyst (Reference Data)
Remote
Job Summary
Business Analyst – Healthcare Reference data role focusing on analyzing business needs, documenting requirements, and supporting solutions involving healthcare reference code sets and claims data. Bridges business stakeholders, coding/policy experts, and technical teams to translate operational needs into clear functional objectives. Remote opportunity with a 2 PM - 11 PM shift, 10+ years of experience expected. Responsibilities include analyzing, designing, and documenting requirements related to ICD/CPT/HCPCS/UB-04 and other healthcare reference data; developing BRDs, functional specs, process flows, and traceability matrices; translating policy and coding requirements into functional objectives; impact analysis for code-set changes and regulatory updates; supporting testing activities and test scenarios; participating in technical reviews; identifying opportunities for business process improvements and data governance enhancements; collaborating with developers, testers, and stakeholders for issue resolution; communicating via documentation, meetings, and presentations.
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
- 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
- Experience with SQL for data analysis and validation
- Strong communication and stakeholder management skills
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