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Senior Healthcare Business Analyst / Behavioral Health SME

Dallas, TX, US • Posted 8 hours ago • Updated 8 hours ago

Full Time

No Travel Required

On-site

Depends on Experience

Fitment

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Job Details

Skills

Healthcare Business Analyst

Summary

Position: Senior Healthcare Business Analyst / Behavioral Health SME

Location: REMOTE

Duration: FTE/Long Term

Note: Key Areas need to be focused

1. Women's health

2. Oncology

3. Health solutions

4. MSK

Requirements

10+ years of Healthcare Payer experience with 5+ years in Behavioral Health (Mental Health & Substance Use Disorders).
Strong understanding of the end-to-end payer lifecycle:
- Eligibility & Enrollment
- Benefits Configuration
- Claims Processing & Adjudication
- Prior Authorization
- Care & Case Management
- Provider Management
- Appeals & Grievances
- Payment Integrity
Deep knowledge of Behavioral Health regulations, including:
- MHPAEA (Mental Health Parity)
- Medicare & Medicaid BH programs
- HIPAA
- CMS and State-specific regulatory requirements
- NCQA/URAC standards
Strong Business Analysis skills:
- Requirements gathering
- BRD/FRD/User Stories
- Process mapping
- Gap analysis
- UAT/SIT support
- Stakeholder management
Experience with payer platforms such as Facets, QNXT, HealthRules, GuidingCare, TruCare, or similar.
Knowledge of healthcare transactions and interoperability standards:
- 837, 835, 834, 270/271
- HL7/FHIR
Strong SQL, data analysis, and system integration understanding.

Thanks and Have a nice day,

Madhan

Lorven Technologies, Inc.

101 Morgan Lane | Suite 209 | Plainsboro | NJ 08536

X 251

Email: | Web:

Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.

Dice Id: 10120137
Position Id: 71856-10367-1790781714
Posted 8 hours ago

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