Healthcare Business Analyst (Onshore)

Healthcare Business Analyst (Onshore)
Location: Cerritos/CA
- Experience: 10+ Years
Domain: US Healthcare (Payer/Provider)

Role Overview
We are seeking an experienced Healthcare Business Analyst (Onshore) to
support eligibility, benefits, claims, and provider data exchange initiatives for one
of the leading healthcare organizations in the United States.
The ideal candidate will bring strong analytical capabilities, hands-on experience with
Availity portal and clearinghouse integrations, and the ability to collaborate
effectively with business, operations, and technical stakeholders across distributed
teams.

Key Responsibilities
Perform end-to-end analysis of payer and provider workflows involving Availity
transactions, including:
o Eligibility & Benefits (270/271)
o Claims Status (276/277)
o Prior Authorization (278)
o Attachments
o Claims & Payments (837/835)
Evaluate business requirements, data flows, and integration patterns to
ensure alignment with Availity capabilities and enterprise operational standards.
Review Availity response data, error codes, payer-specific rules, and
transaction exceptions to ensure accuracy, completeness, and EDI
compliance.
Support implementation, enhancement, and optimization of:
o Availity Portal features
o Availity APIs

o Clearinghouse configurations
Lead requirements-gathering sessions with operations, product, and technical
teams.
Create and maintain:
o Functional requirement documents (FRDs)
o User stories and acceptance criteria
o Workflow and process diagrams
Assess business impact of:
o Availity-related changes
o EDI mapping updates
o Upstream and downstream process modifications
Perform root cause analysis for:
o Transaction failures
o Eligibility discrepancies
o Authorization and claims rejections
Develop test plans, support User Acceptance Testing (UAT), and validate end-
to-end transaction accuracy.
Prepare documentation including:
o Analysis summaries
o Reporting dashboards
o Issue and resolution logs
o Stakeholder communication materials
Research and interpret:
o Clearinghouse rules
o EDI compliance requirements
o Payer implementation guides
Act as a Subject Matter Expert (SME) for Availity operations, payer-provider
workflows, and healthcare EDI standards.

Required Qualifications
Bachelor s degree in Healthcare Administration, Information Systems,
Business, or a related field.
5+ years of experience as a Healthcare Business Analyst in payer or provider
environments.
Hands-on experience with Availity Portal, Availity APIs, or clearinghouse
integrations (mandatory).
Strong understanding of HIPAA-standard EDI transactions, including:
o 270/271
o 276/277
o 278
o 837
o 835
Experience working across:
o Eligibility & benefits
o Claims processing
o Prior authorization workflows
Knowledge of healthcare data protection standards and payer-provider
transaction guidelines.
Experience supporting compliance reviews, audits, or healthcare operational
processes.
Strong analytical skills with the ability to troubleshoot transaction-level issues and
interpret Availity error responses.
Excellent written and verbal communication skills.
Ability to work directly with U.S.-based stakeholders and cross-functional
teams.
Proficiency with tools such as:
o MS Word, Excel

o JIRA
o Confluence
o EDI / Availity reporting formats