[Remote] Business Analyst
Note: The job is a remote job and is open to candidates in USA. Fractal is a strategic AI partner to Fortune 500 companies, aiming to enhance human decision-making in enterprises. The Business Analyst will work with various teams to analyze business processes and define requirements to improve clinical outcomes and operational efficiency.
Responsibilities
- Provider Network Analysis
- Analyze provider network operations including contracting, credentialing, directory management, network adequacy, and access standards
- Support initiatives related to network optimization, provider performance, and value‑based care arrangements
- Gather and document requirements for provider data management, directory accuracy, and compliance reporting
- Act as a liaison between business users and technical teams for provider network systems
- Analyze Care Management workflows, including utilization management, case management, disease management, and population health programs
- Support process improvements around prior authorization, referrals, transitions of care, and closure of care gaps
- Translate clinical and operational needs into clear business and system requirements
- Assist in the measurement and reporting of care outcomes, quality metrics, and utilization trends
- Conduct stakeholder interviews, workshops, and current‑state/future‑state process analysis
- Develop Business Requirement Documents (BRDs), Functional Requirement Documents (FRDs), process flows, and user stories
- Support system enhancements, integrations, and data initiatives related to provider and care management platforms
- Validate solutions through UAT planning, execution, and defect triage
- Analyze healthcare data related to cost, utilization, quality, risk stratification, and provider performance
- Support reporting for regulatory and accreditation requirements (e.g., CMS, NCQA, state mandates)
- Ensure alignment with healthcare standards such as ICD‑10, CPT, HCPCS, HEDIS, and FHIR where applicable
Skills
- 6–10+ years of experience as a Business Analyst in healthcare
- Strong hands‑on experience with Provider Network operations and Care Management programs
- Experience working with payer systems or healthcare platforms supporting network and care management functions
- Provider contracting, credentialing, and directory management
- Care Management, Utilization Management, Case/Disease Management models
- Value‑Based Care, ACOs, and quality improvement initiatives
- Understanding of payer workflows and end‑to‑end member/provider lifecycle
- Requirements elicitation and documentation (BRD, FRD, user stories)
- Process modeling tools (Visio, Lucidchart, BPMN)
- Agile and/or Waterfall delivery methodologies
- Data analysis using SQL, Excel, or BI tools (reported or self‑service)
- Familiarity with healthcare platforms such as care management systems, provider data systems, and claims platforms
- Strong communication skills with clinical, business, and technical stakeholders
- Ability to translate complex clinical and operational concepts into actionable requirements
- Analytical mindset with strong problem‑solving capabilities
- Proven ability to manage multiple priorities in a fast‑paced environment
- Experience supporting HEDIS, Stars, Risk Adjustment, or Quality programs
- Exposure to FHIR‑based integrations and healthcare interoperability initiatives
- Certification such as CBAP, CCBA, or PMI‑PBA
- Experience in payer modernization or digital health transformation initiatives
Benefits
- Health, dental, vision, life insurance, and disability plans
- Company 401(k) Plan
- 11 paid holidays
- 12 weeks of Parental Leave
- Free time PTO policy
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