Business Analyst - Prior Authorization

Job Summary

To support healthcare claims and reimbursement initiatives, the long-term contract Business Analyst - Prior Authorization will work mostly remotely with one day per month in Quincy, MA, focusing on provider reimbursement, claims processing, and prior authorization workflows while collaborating with stakeholders and technical teams to enhance operational efficiency.

Key Responsibilities

• Lead requirements gathering sessions and document business, functional, and system requirements
• Conduct gap analysis and recommend process improvements for claims and prior authorization initiatives
• Develop and execute test strategies, validate results, and support user acceptance testing (UAT)

Required Qualifications

• Bachelor's degree in Business, Information Technology, Healthcare Administration, or a related field; equivalent experience considered
• 3+ years of Business Analyst experience in healthcare, health insurance, or managed care environments
• Strong knowledge of Prior Authorization, claims processing, and healthcare reimbursement processes
• Experience gathering business requirements and supporting full SDLC projects
• Understanding of Agile and/or traditional project methodologies