Healthcare Business Analyst
Satwic Inc
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Job Details
Skills
- Business Analysis
- HL7
- Health Care
- SQL
- Medicaid
- Healthcare Payer
- Artificial Intelligence
- Medicare
- QNXT
- System Integration
Summary
10+ years of Healthcare Payer experience with 5+ years in Behavioral Health (Mental Health & Substance Use Disorders).
Seeking a seasoned Behavioral Health SME with strong Business Analyst and healthcare systems expertise to support payer transformation initiatives. The ideal candidate will have deep knowledge of Behavioral Health operations, end-to-end payer processes, and healthcare regulations, along with the ability to bridge business and technology teams.
Key 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.
Preferred
- Experience with Commercial, Medicare, and Medicaid lines of business.
- Exposure to Behavioral Health care management, utilization management, and value-based care programs.
- Experience working on payer modernization, data, AI, or digital transformation initiatives.
Ideal Candidate
The ideal candidate will be a Behavioral Health payer SME who combines deep business process knowledge, regulatory expertise, system knowledge, and business analysis skills, with proven experience across:
Behavioral Health + Claims + Eligibility + Benefits + Care Management + Provider Operations + Regulatory Compliance + Payer Technology Platforms.
This person should be capable of driving both strategic business discussions and detailed system-level solution design discussions with equal effectiveness
- Dice Id: RTL122112
- Position Id: 9098808
- Posted 1 hour ago
Company Info
About Satwic Inc
Satwic Inc., is an Information Technology consulting services firm that helps clients make intelligent decisions with their data. Our services are optimized to provide compelling value to customers by leveraging our global delivery model, highly talented team of seasoned professionals and refined processes. We have an impeccable track record in delivering Business Intelligence, Data Integration and Data Management solutions.
The name 'Satwic' is derived from the Sanskrit word 'sattwa,' evoking efficiency and optimization in our approach to business processes and technology. As our name suggests, we believe in delivering customer satisfaction using optimal resources and industry best practices. We are based in Glendale (Southern California, USA) with an offshore development center in Bangalore, India.
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