Sr. Business Systems Analyst – Healthcare Operations & Patient Support ; G.C / U.S.C
12+ Months
Remote (East Coast Preferred)
Role Summary:
Seeking a client-facing Senior Business Systems Analyst to bridge business and technology for patient support and reimbursement programs. You will lead requirements, process design, and solution delivery across CRM, claims, and integration platforms supporting providers, patients, specialty pharmacy partners, and payer interactions. This role requires strong healthcare domain expertise, composure under pressure, and the ability to work independently across the full analysis lifecycle. Experience with IQVIA data and applications is highly preferred.
Key Responsibilities:
- Lead discovery with providers, patients, and business stakeholders to elicit and clarify complex needs
- Translate business needs into clear functional/technical requirements and solution recommendations
- Produce BRDs, functional specs, user stories, acceptance criteria, data mappings, and process flows (as-is/to-be)
- Support end-to-end patient services processes: benefits investigation, prior authorization, co-pay assistance, reimbursement/claims, specialty pharmacy coordination, and prescription lifecycle
- Analyze enterprise applications, integrations, data flows, and workflows to identify gaps and optimization opportunities
- Partner with product, engineering, QA, and operations to deliver practical, compliant solutions; support backlog grooming and release planning
- Facilitate UAT planning and execution; triage production issues and guide root-cause analysis
- Represent the organization in client/provider forums; manage escalations involving patients, medications, and insurance challenges with urgency and empathy
- Ensure adherence to HIPAA and data privacy standards; contribute to audit/readiness documentation
- Mentor junior analysts; establish best practices, templates, and standards for requirements and documentation
- Work autonomously across the SDLC/Agile lifecycle; contribute to continuous improvement of processes and metrics
Required Qualifications:
- 5+ years as a Business Systems Analyst (or similar), including end-to-end requirements and solution delivery
- 3+ years in healthcare delivery, patient support services, specialty pharmacy, or revenue cycle domains
- Hands-on experience with insurance and reimbursement processes: eligibility/benefits verification, prior auth, co-pay programs, claims/denials, and patient assistance
- Demonstrated strength creating BRDs, functional requirements, user stories, acceptance criteria, and process models
- Experience with enterprise CRM and case management (e.g., Salesforce Health Cloud, Service/Sales Cloud, or Microsoft Dynamics) and exposure to claims/benefit systems
- Solid understanding of integrations and data exchange (APIs, batch/ETL, EDI) and ability to produce data mapping and interface specifications
- Proficiency with Jira/Confluence (or similar), and working knowledge of SQL for data validation and analysis
- Exceptional client-facing communication, stakeholder management, and facilitation skills; able to perform in high-stress, time-sensitive situations
- Familiarity with Agile/Scrum and standard SDLC practices; strong documentation discipline
Highly Preferred:
- Direct experience with IQVIA datasets, platforms, and applications
- Knowledge of EDI healthcare transactions (e.g., 270/271, 276/277, 835/837)
- Exposure to claims adjudication platforms, reimbursement hubs, or patient services operations
- Experience with data visualization/reporting (Power BI, Tableau) and integration tools (MuleSoft, Boomi) a plus
Core Competencies:
- Healthcare domain expertise and regulatory awareness (HIPAA, PHI handling)
- Analytical problem solving and systems thinking
- Requirements elicitation and traceability
- Process optimization and workflow design
- Stakeholder influence and conflict resolution
- Coaching and knowledge sharing
Tools and Technologies:
- Jira/Confluence or Azure DevOps
- Salesforce (Health Cloud/Service Cloud) and/or Microsoft Dynamics 365
- Claims/benefit systems; CRM/case management platforms
- SQL; Postman/Swagger for API review; Visio/Lucidchart for process mapping
Education:
- Bachelor’s degree in Information Systems, Computer Science, Business, Healthcare Administration, or related field; or equivalent experience
Work Conditions:
- Remote or hybrid; occasional travel to client/provider sites as needed
- Flexibility to support critical escalations and release activities outside standard hours when required
Success Indicators (first 6–12 months):
- High-quality, testable requirements with strong traceability driving on-time, on-scope delivery
- Reduced defects and rework through proactive analysis and clear acceptance criteria
- Improved cycle times for benefits verification/prior auth/co-pay workflows
- Positive stakeholder feedback and measurable impact on patient/provider experience
- Established standards and mentorship improving throughput of the BSA team
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