Business Analyst (Healthcare Domain, US Healthcare)

Business Analyst (Healthcare Domain, US Healthcare)
Experience: 7-10 years (minimum 5 in healthcare)
Location: Remote
Share your CV at SANJAY.C@ELITESQUAD.AI
Role Summary
We are looking for a senior Business Analyst with deep healthcare domain expertise and hands-on exposure to the US healthcare ecosystem. This person will not just document requirements. They will challenge assumptions, spot gaps in the product and its workflows, and bring fresh ideas that improve the product's value for providers, payers, and patients.
Key Responsibilities
Elicit, analyze, and document business and functional requirements (BRD, FRD, user stories, acceptance criteria) with stakeholders.
Map current-state and future-state workflows, and identify gaps, inefficiencies, and compliance risks.
Proactively suggest product enhancements and new features based on market trends, regulation changes, and user pain points.
Partner with the Product Owner to build and prioritize the backlog and roadmap.
Translate clinical and operational needs into clear specifications for engineering and QA teams.
Define data and integration requirements (HL7, FHIR, EDI X12) across EHR, claims, and billing systems.
Support UAT, validate delivered features against requirements, and manage change requests.
Conduct competitor and market analysis of healthcare products and solutions.
Make sure all solutions meet HIPAA and other regulatory requirements.
Create process flows, wireframes, and dashboards to communicate ideas clearly.
Required Domain Knowledge
US healthcare landscape: providers, payers, PBMs, pharma, and the patient journey.
Revenue cycle management (RCM): eligibility, prior authorization, claims, denials, and payment posting.
Standards and regulations: HIPAA, HITECH, CMS guidelines, Meaningful Use/MIPS, and 21st Century Cures Act.
Code sets: ICD-10, CPT, HCPCS, DRG, and LOINC.
Interoperability: HL7 v2/v3, FHIR, CCD/CDA, and EDI transactions (837, 835, 270/271, 278).
Systems: EHR/EMR (Epic, Cerner, Athenahealth, etc.), practice management, and claims platforms.
Value-based care: risk adjustment, quality measures (HEDIS), and population health.
Required Skills
Strong requirements gathering, gap analysis, and root-cause analysis.
Excellent skills in user stories, process modeling (BPMN/UML), and wireframing.
Hands-on experience with Agile/Scrum, JIRA, and Confluence.
Working knowledge of SQL and data analysis; familiarity with BI tools is a plus.
Excellent written and verbal communication, and the ability to present to senior stakeholders.
Strong analytical and critical thinking, with an ownership mindset.
What Sets a Great Candidate Apart
Has worked directly with US clients and understands their operational realities.
Brings ideas on automation, AI/ML use cases, and patient experience improvements.
Can question the "why" behind a requirement and propose better alternatives.
Understands how product decisions affect clinical, financial, and compliance outcomes.
Preferred Qualifications
Bachelor's degree in Healthcare, Life Sciences, IT, or a related field; MBA is a plus.
Certifications such as CBAP, PMI-PBA, CPHIMS, or healthcare-specific credentials.
Experience with cloud-based healthcare platforms and data migration projects.

Work arrangement
Yes