Business Analyst – Prior Authorization & Claims (Medicaid)
Location: Quincy, MA (Hybrid)
Schedule: Monday-Friday, 9:00 AM – 5:00 PM
Job Type: Contract (12 months)
Pay Range: $60 – $62
About the Opportunity
We are seeking an experienced Business Analyst with Prior Authorization (PA) and Medicaid claims expertise to support a large-scale healthcare technology and operations environment. This role will focus on provider reimbursement, claims processing, prior authorizations, referrals, and system enhancements supporting government healthcare programs.
The ideal candidate will have strong business analysis experience, a solid understanding of healthcare operations and claims processing, and the ability to collaborate with business stakeholders, vendors, and technical teams throughout the full system development lifecycle.
Key Responsibilities
- Lead and participate in requirements gathering and Joint Application Design (JAD) sessions with stakeholders.
- Analyze business processes and identify opportunities for system enhancements.
- Develop and document business and functional requirements.
- Create test strategies, test scenarios, and test cases based on business requirements.
- Execute and validate testing efforts, ensuring solutions meet business needs.
- Support implementation, stabilization, and post-release activities.
- Collaborate with vendors and technical teams to ensure requirements are fully understood and tested.
- Communicate project updates, risks, and changes to stakeholders.
- Assist in the development of user documentation and training materials.
- Support business users with system-related questions and issue resolution.
- Perform data analysis and validation using SQL.
- Provide backup support to other Business Analysts as needed.
Required Qualifications
- Bachelor's degree in Business, Information Technology, Healthcare Administration, or a related field, or equivalent healthcare industry experience.
- 3+ years of Business Analyst experience supporting healthcare systems or healthcare operations.
- Strong understanding of healthcare claims processing and reimbursement workflows.
- Experience with Prior Authorizations (PA), PAS, referrals, and related healthcare processes.
- Knowledge of the Software Development Life Cycle (SDLC).
- Strong analytical and problem-solving skills.
- Excellent written and verbal communication skills.
- Ability to work independently and collaboratively within cross-functional teams.
Preferred Qualifications
- Medicaid or government healthcare program experience.
- Experience working with MMIS or comparable healthcare claims systems.
- Knowledge of HIPAA claims and payment transaction processing.
- Proficiency with SQL for data analysis and validation.
- Experience working in Agile environments.
- Familiarity with healthcare interoperability standards and X12 transactions.
- Proven ability to manage multiple priorities in a fast-paced environment.
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