Senior Business Analyst

Required Skills & Experience

• 7+ years of experience in managed-care network adequacy, provider-network operations, regulatory compliance, or health-plan audit and remediation
• 3+ years of experience conducting system, data, control, or reporting validation in a health-plan environment
• Strong healthcare or health-plan experience
• Experience interpreting network-adequacy requirements across multiple jurisdictions or lines of business
• Experience writing and revising corporate policies, SOPs, control procedures, and audit responses
• Experience leading requirements gathering through testing for a system implementation or major reporting change
• Strong functional testing and UAT experience
• Ability to translate complex regulatory language into clear business requirements and test cases

Nice to Have Skills & Experience

• Quest Analytics experience
• Understanding of time-and-distance standards, appointment wait times, provider-to-enrollee ratios, and provider directory accuracy
• Familiarity with CMS, state regulatory, and NCQA network-adequacy standards
• Experience with provider data, specialty and location mapping, credentialing interfaces, and directory feeds
• Experience building traceability matrices connecting requirements, policies, system configurations, testing, and evidence

Job Description

Seeking a Senior Business Analyst to support a large healthcare organization with a provider network and network adequacy initiative. This individual will partner across business, compliance, operations, data, and technology teams to translate regulatory and operational needs into requirements, policies, testing, and implementation deliverables.