Healthcare System Analyst – Payer Systems

• Position: Healthcare System Analyst – Payer Systems
• Location: Woodland Hills, CA / Mason, OH
• Duration: Full Time / Long Term Contract

Job Description:

• Overall 10+ years of experience required
• A technical system analyst with good understanding of the healthcare process flow – Eligibility & Enrollment – Provider contract pricing – Claims adjudication – Billing – Appeals and Grievances.
• Technical understanding of Sql and Dot net – full stack preferable.
• knowledge of Facets platform from a developer point of view – i.e. data models, architecture, and process flow.
• Good experience in working with Business and technical teams to prepare system requirements and Technical and functional documents.
• Looking for hands-on Facets systems analyst experience, including with deep benefits + claims knowledge, strong data troubleshooting ability, and clear ownership of real production issues.
• Benefits knowledge: Strong knowledge of eligibility, enrollment, benefit plans, coverage rules, and 270/271 transactions. Demonstrated a clear understanding of how benefits impact claims adjudication.
• Claims adjudication knowledge: Good understanding of claims adjudication workflows, provider pricing, claim validations, denials, remittance advice, UAT, and production support activities.
• Facets experience: Relevant Facets exposure across member enrollment, provider enrollment, eligibility, adjudication, and provider contracting modules. Experience appears primarily from a System Analyst perspective.
• Requirements analysis: Strong requirements gathering and analysis skills. Demonstrated experience with stakeholder workshops, process mapping, business requirements, wireframes, prioritization, and translation into technical specifications.
• SQL/data analysis: Comfortable using SQL for root cause analysis, data validation, troubleshooting, and UAT support. Demonstrated a structured approach to investigating data issues.
• Production issue investigation: Provided a solid example of investigating eligibility-related production issues, performing RCA, coordinating with ETL teams, and driving resolution while communicating effectively with business stakeholders.
• Agile/SAFe experience: Experience working in Agile/SAFe environments and using Azure DevOps for backlog and sprint management.
• Communication and documentation examples: Demonstrated strong stakeholder communication and documentation experience, including BRDs, workflow diagrams, data mapping documents, UAT artifacts, release notes, and defect tracking.

Looking forward for your reply.