Business Analyst - Operations (Healthcare)

TL;DR

Business Analyst - Operations (Healthcare): Supporting Payment Integrity operations by documenting requirements and analyzing healthcare claims data with an accent on reducing improper payments and improving financial accuracy. Focus on translating business needs into system requirements for PI products and validating audit findings through data analysis.

Company

hirify.global provides solutions for Payment Integrity in the healthcare ecosystem to reduce waste and improve financial accuracy.

What you will do

• Elicit and document business requirements (BRDs, FRDs) and detailed acceptance criteria.
• Translate business needs into system requirements for PI products, including DRG review, HBA, COB, and data mining.
• Conduct claims data analysis to identify trends and validate audit findings.
• Collaborate with IT, QA, and operations teams to ensure requirements are implemented and tested accurately.
• Track and report performance metrics, savings impact, and accuracy rates for PI solutions.
• Stay current on payer policy changes and regulatory guidance such as CMS/NCCI updates.

Requirements

• Bachelor’s degree in Business, Healthcare Administration, Data Analytics, or a related field.
• 3+ years of experience as a Business Analyst in healthcare, payer, or Payment Integrity (PI) environments.
• Strong understanding of claims processing (professional, facility, pharmacy) and transactions (837, 835, COB, EOBs).
• Proficiency in SQL and Excel for data analysis.
• Proven experience in documenting detailed requirements and managing business stakeholders.

Nice to have

• Prior experience with DRG auditing, HBA, COB, IBR, or edit engine configuration.
• Knowledge of medical coding standards including ICD, CPT, and HCPCS.
• Familiarity with payer SIU/FWA operations or subrogation.
• Experience with Agile methodologies and tools such as Jira and Confluence.