Senior Business Systems Analyst

This is a fully remote position, open to applicants in Alabama, +43 more locations.

📋 Description

• Facilitate collaboration between business and IT stakeholders to convert intricate business requirements into both functional and non-functional technical specifications.

• Gather, analyze, and document business and functional requirements for Payment Integrity prepay and postpay solutions, which includes PISCES, vendor editors, and claims-system integrations.

• Collaborate with Product Owners, Architects, Engineering, QA, and vendor partners to develop clear, testable requirements and ensure traceability in Jira/Confluence.

• Engage in Agile ceremonies and provide clarification on requirements for developers and testers.

• Investigate claims, edit, and vendor data using SQL and reporting tools to address issues, validate outcomes, and assist in root-cause analysis.

• Outline current and future state processes and data flows, including vendor data feeds and claims write-back patterns.

• Assist in test planning, coordinate SIT/UAT, and obtain business sign-off.

• Act as a liaison to Payment Integrity operations, SIU, and health plan stakeholders; communicate status updates, risks, and dependencies.

• Mentor junior and contract BSAs while promoting consistent standards in requirements.

• Collect and validate business and technology requirements; establish scope, project impact, outcome criteria, and metrics.

• Evaluate requirements for completeness, consistency, feasibility, and adherence to standards.

• Convert conceptual user requirements into functional specifications.

• Develop systems and business process models, specifications, diagrams, and charts.

• Translate user requirements into viable options and convey them to business stakeholders.

• Oversee and monitor requirements throughout the project lifecycle.

• Communicate changes in requirements and solutions to project managers, sponsors, and stakeholders.

• Organize and coordinate user acceptance testing.

• Track IT service levels as specified in SLAs.

• Research and enhance requirements-gathering processes and identify opportunities for efficiency.

• Maintain system protocols, procedures, and user documentation.

• Provide help desk support and train users accordingly.

• Compile technical reports by collecting, analyzing, and summarizing information and trends.

• Clarify requirements and implement solutions that align with business needs.

• Perform additional duties as assigned while adhering to policies and standards.

⛳️ Requirements

• Bachelor's degree in a quantitative or business field (e.g., statistics, mathematics, engineering, computer science), or equivalent experience gained through relevant knowledge, duties, scope, and skills.

• A minimum of 4–6 years of related experience is required.

• 4–6+ years of experience in business systems analysis, ideally in healthcare payer, claims, or Payment Integrity / FWA environments.

• Proficient understanding of claims adjudication and coding concepts, including CPT/HCPCS, ICD-10, NCCI, claim editing, and prepay/postpay review.

• Experience with Facets, Amisys, ClaimsXten, Cotiviti, or Machinify is highly advantageous.

• Strong discipline in requirements management: BRDs, user stories, acceptance criteria, process and data-flow mapping, and requirements traceability.

• Proficient data analysis skills; SQL expertise is essential.

• Familiarity with Power BI/Excel is preferred.

• Experience with data processing is desirable.

• Understanding of healthcare payer business functions and operations.

• Knowledge of Agile Software Development and the Software Development Life Cycle.

🏝️ Benefits

• Competitive compensation.

• Health insurance coverage.

• 401K plan.

• Stock purchase options.

• Tuition reimbursement opportunities.

• Paid time off in addition to holidays.

• Flexible work arrangements including remote, hybrid, field, or office schedules.

• Additional incentive programs may be included in total compensation.

• Equal opportunity employer dedicated to diversity.