Business Analyst - Healthcare Reference

Summary As a

Business Analyst - Healthcare Reference at Gainwell, you will contribute to healthcare technology delivery by analyzing business needs, documenting requirements, and supporting solutions involving healthcare reference code sets and claims data. You will act as a bridge between business stakeholders, coding/policy experts, and technical teams to translate operational needs into clear and actionable requirements. This role is strictly involved in business analysis, requirements documentation, and healthcare reference data support activities and does not involve direct access to Protected Health Information (PHI), Personally Identifiable Information (PII), or any secured or confidential client data. The work is limited to analysis of healthcare claims, reference code sets, and system configurations using governed datasets and does not include handling or processing of sensitive health or personal information

Your role in our mission

• Analyze, design, and document business requirements related to healthcare claims, reference data, and code sets
• Work with stakeholders to gather and define requirements involving ICD, CPT, HCPCS, UB‑04, revenue codes, provider taxonomy, and other healthcare reference data
• Develop and maintain business analysis artifacts such as BRDs, functional specifications, process flows, decision tables, and traceability matrices
• Translate business, policy, and coding requirements into clear functional objectives for technical teams
• Perform impact analysis for code‑set changes, regulatory updates, and policy changes across claims processing systems
• Support testing activities, including defining test scenarios and validating system outputs
• Participate in technical reviews and project discussions to ensure requirement alignment across lifecycle phases
• Identify opportunities for business process improvement and data governance enhancements
• Collaborate with developers, testers, and stakeholders for issue resolution, defect triage, and root‑cause analysis
• Communicate effectively with business and technical teams through documentation, meetings, and presentations

What We're Looking For

• 6–10 years of experience in a Business Analyst role
• Strong experience in healthcare domain (Medicaid / Medicare / claims processing)
• Working knowledge of healthcare code sets, including: + ICD‑10‑CM / ICD‑10‑PCS + CPT, HCPCS + UB‑04 institutional billing elements + Revenue codes, modifiers, type of bill, place of service
• Experience in requirements gathering, analysis, and documentation
• Strong understanding of claims lifecycle, adjudication, and reference data workflows
• Experience working with SDLC processes, testing, and system configuration concepts
• Strong analytical and problem‑solving skills
• Proficiency in Microsoft Excel and data analysis tools
• Strong communication and stakeholder management skills

Preferred Skills:

• Experience with MMIS systems or healthcare program implementations
• Knowledge of HIPAA transactions and X12 claims (837, 835, etc.)
• Experience with SQL for data analysis and validation
• Familiarity with ALM tools, Jira, ServiceNow, or similar platforms
• Experience with data governance, reference‑data management, or claims edits/billing rules
• Exposure to regulatory compliance and healthcare audits
• Business analysis certifications or healthcare coding knowledge

What You Should Expect In This Role

• Remote work environment with shift time (2 pm -11pm IST)