Business Analyst
Philadelphia, PA
This role is for a business analysis to support data-exchange initiatives in Data
Integration Department within Enterprise Data office with a strong focus on HL7
standards (FHIR, CCD, ADT, SIU) to ensure regulatory compliance (CMS, ONC) and data
integrity. The position requires deep healthcare data expertise and the ability to
independently drive requirements, translate business needs into technical
specifications, partner closely with IT teams, and mentor junior Business Analysts.
Job Functions:
• Conduct end-to-end requirements gathering, independently managing discovery,
analysis, and solution definition with business and IT stakeholders.
• Serve as a subject-matter expert on CMS Interoperability and HL7 exchange
protocols, including FHIR, CCDs, ADTs, etc.
• Perform hands-on data analysis using SQL, Databricks, and related tools to
validate data, troubleshoot issues, and support design decisions.
• Document business and technical requirements, source-to-target mappings,
data specifications, business rules, and process flows.
• Support validation and QA by reviewing data outputs, test cases, and results to
ensure accuracy and compliance.
• Collaborate with internal teams and external partners with minimal supervision
to gather requirements, drive key decisions, and support successful
implementations.
• Communicate business and process solutions, recommendations, and issues to
ACFC management on a regular basis.
• Document all business process flows related to interoperability initiatives.
• Apply working knowledge of ACFC Managed Care functions (HealthCare Services,
Claims, Enrollment, Quality/HEDIS, Risk Adjustment, Care Management,
Utilization Management) to support problem-solving and solution design.
• Provide strong communication and status updates to business and IT
stakeholders and management.
• Build consensus among users, IT, and senior leadership on business problems
and solution approaches.
• Address most inquiries independently, escalating only when appropriate.
• Distinguish between routine and sensitive matters and promptly apprise
management when needed.
• Ensure requests are addressed promptly, professionally, and with persistence in
gathering required information.
• Meet with external vendors to evaluate products and ensure ACFC requirements
are met.
• Communicate effectively with senior and mid-level management.
• Understand chain of command, decision-making roles, and communicate
accordingly.
• Demonstrate strong analytical and problem-solving skills, including evaluating
alternatives, recommending solutions, and articulating impacts.
• Produce clear, well-structured written and verbal communications.
• Brief management appropriately when issues require senior-level attention.
Qualifications:
• 5–10 years of experience in healthcare IT, data integration, or business analysis.
• Experience with FHIR, HL7 clinical data-exchange standards (CCD/ADT/SIU)
and healthcare terminology (LOINC, ICD-10, CPT, etc.).
• Ability to interpret large datasets and deliver evidence-based recommendations.
• Strong organizational, analytical, and interpersonal skills.
• Ability to communicate effectively at all organizational levels.
• Advanced proficiency with Microsoft Office Suite.
• Proficiency in SQL, Databricks, and data validation techniques.
• Experience in Agile Delivery with usage of tools like Azure DevOps or JIRA
• General knowledge of healthcare operations (HEDIS, Prior Authorizations, etc.)
in a managed-care environment.
• Demonstrated ability to work independently and collaboratively.
• Strong documentation, communication, and problem-solving skills.
• Bachelor’s degree or equivalent experience
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