Business Analyst - Healthcare Interoperability & Data Integration

Key Responsibilities

• Lead end-to-end requirements gathering, analysis, and documentation with business and technology stakeholders.
• Act as a subject matter expert for healthcare interoperability standards including FHIR, HL7, CCD, ADT, SIU, and CMS interoperability requirements.
• Translate business requirements into functional and technical specifications, process flows, business rules, and source-to-target mappings.
• Perform hands-on data analysis and validation using SQL, Databricks, and related data tools.
• Support testing and quality assurance activities, including review of test cases, data outputs, and validation results.
• Partner with internal teams and external vendors to support healthcare data exchange implementations.
• Document and analyze interoperability-related business processes and workflows.
• Collaborate with stakeholders across Healthcare Services, Claims, Enrollment, Quality/HEDIS, Risk Adjustment, Care Management, and Utilization Management.
• Facilitate discussions, drive consensus, and communicate recommendations to business and technology leadership.
• Provide regular project status updates, identify risks/issues, and support resolution efforts.
• Mentor junior Business Analysts and promote best practices in requirements management and documentation.

Required Qualifications

• Min 9+ years of experience as a Business Analyst supporting healthcare IT, healthcare data integration, or interoperability initiatives.
• Strong experience with FHIR, HL7, CCD, ADT, and SIU healthcare data exchange standards.
• Knowledge of healthcare data domains and terminology including ICD-10, CPT, LOINC, and related standards.
• Hands-on experience with SQL and data analysis/validation.
• Experience with Databricks or similar modern data platforms.
• Experience working within Agile teams using tools such as Azure DevOps or JIRA.
• Strong documentation skills, including business requirements, use cases, process flows, and data mapping.
• Knowledge of managed care processes including Claims, Enrollment, HEDIS, Prior Authorization, Care Management, and Risk Adjustment.
• Excellent communication, stakeholder management, and problem-solving skills.
• Ability to operate independently in a fast-paced, cross-functional environment.
• Bachelor's degree or equivalent combination of education and experience.

Preferred Qualifications

• Experience with CMS Interoperability, Healthcare Payer, or Managed Care organizations.
• Experience supporting enterprise data integration or interoperability programs.
• Prior experience working with healthcare vendors, provider systems, or EHR integrations.
• Philadelphia-area candidates preferred, though not required.

Educational Qualifications: -

Engineering Degree BE/ME/BTech/MTech/BSc/MSc.

Technical certification in multiple technologies is desirable.

Good to have skills: - Healthcare experience