Business Analyst

Role :Business Analyst – Healthcare Data Integration

Location : Philadelphia, PA (Hybrid)

Contract role

Looking for 10 years

Job Summary

We are seeking an experienced Business Analyst to support data-exchange initiatives within the Data Integration Department of the Enterprise Data Office. The role will focus on healthcare data integration and interoperability, with strong expertise in HL7 standards including FHIR, CCD, ADT, and SIU, ensuring regulatory compliance with CMS and ONC requirements and maintaining data integrity.

The ideal candidate will have strong healthcare data expertise, hands-on experience with SQL and Databricks, and the ability to independently gather requirements, translate business needs into technical specifications, collaborate with IT teams, and mentor junior Business Analysts.

Roles and Responsibilities

• Conduct end-to-end requirements gathering, including discovery, analysis, and solution definition with business and IT stakeholders.
• Serve as a subject matter expert on CMS Interoperability and healthcare data-exchange standards, including FHIR, HL7, CCD, ADT, and SIU.
• Perform hands-on data analysis using SQL, Databricks, and related tools to validate data, troubleshoot issues, and support solution design.
• Translate business requirements into detailed technical and functional specifications.
• Develop and maintain:
• Source-to-Target Mappings
• Data Specifications
• Business Rules
• Business and Technical Requirements
• Process Flows
• Data Validation Requirements
• Support QA and data validation by reviewing data outputs, test cases, and test results to ensure accuracy, completeness, and compliance.
• Collaborate with internal business teams, IT teams, external vendors, and partners with minimal supervision.
• Drive key decisions and support successful implementation of data-exchange and interoperability initiatives.
• Document business process flows related to healthcare interoperability initiatives.
• Apply knowledge of Managed Care functions, including:
• Healthcare Services
• Claims
• Enrollment
• Quality/HEDIS
• Risk Adjustment
• Care Management
• Utilization Management
• Prior Authorization
• Provide regular status updates, recommendations, issues, and project communications to business stakeholders and management.
• Build consensus among business users, IT teams, vendors, and senior leadership regarding business problems and solution approaches.
• Address business and technical inquiries independently and escalate complex or sensitive issues when appropriate.
• Evaluate alternatives, recommend solutions, and clearly communicate business and technical impacts.
• Meet with external vendors to evaluate products and solutions and ensure organizational requirements are met.
• Communicate effectively with senior and mid-level management.
• Understand organizational chain of command, decision-making roles, and appropriate communication channels.
• Produce clear, concise, and well-structured written and verbal communications.
• Brief management appropriately when issues require senior-level attention.
• Mentor and provide guidance to junior Business Analysts.

Required Qualifications

• 5–10 years of experience in Healthcare IT, Data Integration, Business Analysis, or a related field.
• Strong experience with FHIR and HL7 healthcare data-exchange standards, including:
• FHIR
• HL7
• CCD
• ADT
• SIU
• Knowledge of healthcare terminology and coding standards such as:
• LOINC
• ICD-10
• CPT
• Strong proficiency in SQL and experience analyzing large healthcare datasets.
• Hands-on experience with Databricks.
• Experience with data validation, data quality, and data troubleshooting.
• Strong experience creating Source-to-Target Mappings, data specifications, business rules, and process flows.
• Knowledge of CMS and ONC interoperability requirements.
• Experience working in Agile delivery environments.
• Experience with Agile tools such as Azure DevOps or JIRA.
• General knowledge of healthcare operations within a Managed Care environment, including HEDIS and Prior Authorization.
• Strong analytical, organizational, interpersonal, problem-solving, and documentation skills.
• Ability to work independently as well as collaboratively with cross-functional teams.
• Ability to interpret large datasets and provide evidence-based recommendations.
• Strong verbal and written communication skills with the ability to interact effectively at all organizational levels.
• Advanced proficiency with Microsoft Office Suite.
• Bachelor’s degree or equivalent professional experience.

Preferred Healthcare Domain Experience

Experience in one or more of the following areas is highly preferred:

• Healthcare Payer / Managed Care
• Claims
• Enrollment
• Quality / HEDIS
• Risk Adjustment
• Care Management
• Utilization Management
• Prior Authorization
• Healthcare Interoperability
• Healthcare Data Integration
• CMS Interoperability