Healthcare Business Systems Analyst (BSA)/Remote
* Location: South Carolina preferred; remote candidates are acceptable.
* Number of Openings: 1 candidate.
* Experience: 5+ years of healthcare IT experience.
Job Summary
We are seeking an experienced Healthcare Business Systems Analyst (BSA) with strong healthcare domain knowledge, business analysis, and data analysis skills to support healthcare data integration, regulatory reporting, and strategic business initiatives.
The ideal candidate will collaborate with business and technical teams to gather and analyze requirements, perform data profiling, create functional and technical documentation, develop source-to-target mappings, and support end-to-end solution delivery.
The successful candidate should be a self-driven professional with strong analytical, problem-solving, and SQL skills, capable of working with large healthcare datasets in Azure and partnering effectively with Development, QA, and Data Architecture teams to deliver quality solutions.
Experience with HEDIS, NCQA Quality Measures, healthcare quality reporting, or regulatory reporting is preferred but not required.
Key Responsibilities
1. Healthcare Data Analysis & Requirements Gathering
* Analyze, map, and create requirements to transform healthcare data from upstream sources like claims, eligibility, provider, encounter, and supplemental data.
* Translate Business and Functional Requirements into detailed technical requirements, User Stories, acceptance criteria, and source-to-target mappings.
* Perform data profiling, impact analysis, and root cause analysis to support solution design and issue resolution.
* Perform complex SQL-based data analysis using Databricks and related tools to validate data, troubleshoot issues, and support design decisions.
2. Documentation & Technical Delivery
* Create and maintain Functional Requirement Documents (FRDs), business rules, process flows, data specifications, and technical documentation.
* Facilitate requirement walkthroughs with Business, Development, QA, and Data Engineering teams to deliver data and application enhancements aligned with business needs.
* Partner with Business, Engineering, and QA teams to deliver healthcare data and product enhancements.
3. Data Quality & Testing
* Support User Acceptance Testing (UAT) by clarifying business requirements, validating delivered functionality, and assisting with defect resolution.
* Implement data quality validations, reconciliation processes, and auditing across data ingestion, transformation, and reporting layers.
4. Healthcare Regulatory & Quality Reporting
* Support healthcare regulatory reporting initiatives, including HEDIS and other quality reporting programs, as applicable.
* Assess impacts across upstream and downstream systems and collaborate with cross-functional teams to support successful implementation.
* Develop ad hoc analyses and reports to support operational, regulatory, and business reporting needs.
* Support reporting and dashboard requirements, including validation of Power BI reports and business metrics.
5. Project & Stakeholder Management
* Participate in Agile ceremonies, including backlog refinement, sprint planning, requirement clarification, sprint reviews, and release planning.
* Identify and communicate project risks, dependencies, and issues to support successful delivery.
* Ensure end-to-end requirement traceability from business needs through design, development, testing, implementation, and production support.
* Support project or enhancement planning by providing effort estimates, identifying dependencies, tracking deliverables, and coordinating cross-functional activities.
* Support production issue analysis and defect resolution by collaborating with Business, QA, and Development teams.
Required Qualifications
* 5+ years of healthcare IT experience.
* Bachelor’s degree in Computer Science, Information Systems, Data Analytics, or a related field.
* Experience working with healthcare data sources, data ingestion, and extraction to HEDIS processes.
* 3+ years of experience working with HEDIS or healthcare quality measurement data.
* Strong expertise with Azure Databricks, including running complex SQL queries for data analysis.
* Power BI/Tableau developer experience.
* Experience with HEDIS audit requirements from the data side is a plus.
* Experience with HL7/FHIR and CMS interoperability.
* Solid understanding of NCQA HEDIS measures, healthcare claims processing, and quality reporting logic.
* Strong analytical, problem-solving, and communication skills.
* At least 3+ years of Data Management and data lake experience in a healthcare payer organization.
* Healthcare experience is required, preferably with a Payer or Managed Care Organization (MCO).
* Experience with healthcare data sources, data ingestion, and extraction.
* Experience with healthcare data domains, including Member, Provider, Claims, Authorization, Pharmacy, and Clinical
