Healthcare Business Analyst (BA)

Reveleer is a healthcare data and analytics company that uses Artificial Intelligence to give health plans across all business lines greater control over their Quality Improvement Risk Adjustment and Member Management programs. With one transformative solution the Reveleer platform enables plans to independently execute and manage every aspect of enrollment provider outreach and data retrieval coding abstraction reporting and submissions. Leveraging proprietary technology robust data sets and subject matter expertise Reveleer provides complete record retrieval and review services so health plans can confidently plan and execute risk quality and member management programs to deliver more value and improved outcomes.

About the Role:

The Healthcare Business Analyst (BA) plays a critical role in bridging the gap between business objectives and technology solutions in healthcare environments. This role involves gathering and analyzing data defining business requirements and ensuring that healthcare systems processes and technologies meet organizational goalswhether related to care quality risk adjustment regulatory compliance member experience or operational efficiency.

Key Responsibilities:

Business Requirements Gathering:

Collaborate with stakeholders (clinical operational technical) to gather document and validate business and functional requirements.

Facilitate workshops interviews and focus groups to identify needs across departments such as Utilization Management Risk Adjustment Quality and Member Services.

Data Analysis & Reporting:

Analyze claims clinical eligibility provider and quality data to uncover trends anomalies and opportunities.

Build dashboards and reports using tools like SQL Tableau Power BI or Excel.

Solution Design & Validation:

Translate business requirements into technical specifications for development teams.

Participate in solution design user acceptance testing (UAT) and validation of healthcare systems (EHR claims systems portals etc.).

Regulatory and Quality Compliance:

Support CMS HEDIS NCQA and other regulatory or audit initiatives through documentation gap analysis and impact assessments.

Track changes to healthcare regulations and ensure that systems/processes remain compliant.

Process Improvement:

Identify inefficiencies in workflows and recommend data- or technology-driven improvements.

Lead process mapping exercises and suggest optimizations to reduce administrative burden or improve patient/member outcomes.

Cross-Functional Collaboration:

Work closely with IT data science product management and clinical operations teams.

Serve as a liaison between technical and non-technical teams to ensure clear communication and mutual understanding.

Qualifications:

Education:

Bachelors degree in Healthcare Administration Public Health Information Systems Business or related field. Masters degree is a plus.

Experience:

37 years of experience in a healthcare-focused BA role (payer provider or health tech environment).

Experience with healthcare data sources such as claims (837/835) enrollment (834) HL7 FHIR or EMRs.

Technical Skills:

Proficiency in SQL and data visualization tools (e.g. Power BI Tableau).

Familiarity with JIRA Confluence or other agile project management tools.

Domain Knowledge:

Understanding of healthcare regulations (CMS HIPAA) payer operations and/or clinical workflows.

Exposure to risk adjustment quality measurement (HEDIS STAR) or care management processes preferred.

Soft Skills:

Excellent analytical problem-solving and communication skills.

Ability to work independently in a fast-paced evolving environment.

Preferred Certifications (Optional):

Certified Business Analysis Professional (CBAP)

Six Sigma or Lean certification

AHIP CPC or other healthcare-specific certifications

Why Join Us:

Opportunity to make a significant impact on healthcare delivery and patient outcomes.

Work with a talented and passionate team dedicated to innovation and excellence.

Competitive salary and benefits package including health insurance stock options and professional development opportunities.

If you are a creative thinker with a passion for design and a commitment to improving healthcare we would love to hear from you!

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities duties or responsibilities that are required of the employee for this job. Duties responsibilities and activities may change at any time with or without advance notice. Any changes may be for an indeterminate time frame.