Bachelor's degree or equivalent experience preferred.
5-10 years of business analysis or equivalent experience required.
5+ years of experience writing technical specifications.
5+ years of data analysis experience in an IT environment.
Strong understanding of data warehousing concepts and relational databases in healthcare management.
Intermediate SQL knowledge with proficient query writing experience required.
Minimum of 2 years of experience in the healthcare industry.
Responsibilities
Provide ongoing business systems analysis and production support for Enrollment, Billing & Provider applications.
Serve as lead analyst for complex eligibility and vendor file initiatives, including requirements gathering and testing coordination.
Analyze and document healthcare EDI and enrollment-related data requirements, focusing on 834 and 820 transactions.
Collaborate with stakeholders, developers, and external vendors to translate business needs into technical requirements.
Support annual Medicare and product implementation activities by performing impact assessments and documenting requirements.
Identify opportunities for operational reconciliation and process improvements, focusing on automation and standardization.
Coordinate testing and implementation activities to resolve data or processing issues.
Benefits
Permanent work authorization in the U.S. required; no visa sponsorship available.
Work location limited to specific states: MA, CT, RI, NH, NY (excluding Burroughs).
Full Job Description
Overview
Brief Summary of purpose:
A Business Systems Analyst III will work on projects that generally involve a complex scope. The BSA III is responsible for analyzing and documenting business requirements, documenting business workflow, developing file mapping and technical specifications, and working with business partners/stakeholders to determine priority of requirements. In addition, assesses system capabilities and interdependencies to define and document business solutions. Works collaboratively with the development team, provides complex technical guidance while applying effective design concepts. The BSA III proposes or seeks alternative solutions, when necessary, to ensure the proper balance between business and technical needs.
This position requires permanent work authorization in the U.S. We will not provide visa sponsorship or accept candidates on OPT/CPT for this role.
We can only hire from the Following states for this position:
MA, CT, RI, NH, NY (not Burroughs )
Responsibilities
Primary Job Responsibilities:
Provides ongoing business systems analysis and production support for Enrollment, Billing & Provider (EBP) applications and processes, with particular focus on eligibility, enrollment, billing, reconciliation, and outbound vendor file processing.
Serves as a lead analyst for complex eligibility and vendor file initiatives, including requirements gathering, business rules analysis, file mapping, BRD development and updates, testing coordination, defect resolution, and implementation support.
Analyzes and documents healthcare EDI and enrollment-related data requirements and mappings, including 834 and 820 transaction processing and associated reconciliation workflows.
Partners closely with business stakeholders, developers, QA, EDI/Integration teams, and external vendors to translate business needs into technical requirements, resolve data or processing issues, and coordinate testing and implementation activities.
Supports annual Medicare and other product implementation activities by performing impact assessments, identifying affected applications and files, defining required changes, documenting requirements, and coordinating readiness across impacted units.
Supports operational reconciliation and process-improvement initiatives, identifying opportunities to automate or standardize file validation, exception handling, monitoring, and business handoffs.
Demonstrated experience with healthcare enrollment, eligibility, billing, provider data and/or EDI transaction processing strongly preferred. Experience with 834/820 transactions, vendor file interfaces, reconciliation processes, and healthcare payer systems is highly desirable.
Qualifications
Education:
Bachelor Degree equivalent experience preferred
Experience:
Requires 5 to 10 years of business analysis, process mapping, etc. or equivalent experience
5+ year experience writing technical specifications or equivalent experience.
5+ year experience in data analysis in an information technology operating environment or equivalent experience.
Excellent understanding of and experience working with data warehousing concepts, relational databases and business applicability in healthcare management.
Intermediate knowledge of SQL and Relational technology and proficient query writing experience or equivalent experience.
Two years Healthcare Industry experience required.
Pay Range Disclosure: In accordance with the Massachusetts Wage Transparency Act, the pay for this position is $ 128,000 annually which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate's experience, skills, and fit with the role's responsibilities.
About Fallon Health
Fallon Health is a non-profit health care services organization that provides health care services designed to meet the unique and changing needs of all we serve. We are committed to providing our members with the highest quality health care products and services, while also providing our employees with a supportive and rewarding work environment. Our mission is to improve the health and well-being of our communities by providing innovative, high-quality, and affordable health care services.
