HealthDataMax delivers a next-generation, AI-enabled platform for continuous HCC and risk adjustment intelligence across Medicare Advantage, Medicaid, and ACA populations. Our agentic-AI platform reviews claims, charts, and CMS submissions to ensure every diagnosis is supported, compliant, and financially accurate helping payers manage RAF accuracy, RADV audit readiness, and CMS submission integrity. We're a fast-growing startup, and your work directly shapes the product.

Role Overview
We're hiring a Business Analyst to bridge US healthcare risk adjustment domain knowledge and our product engineering team. You'll translate complex risk adjustment, encounter data, and CMS compliance workflows into clear, actionable product requirements.

Key Responsibilities

- Elicit, document, and validate business and functional requirements for risk adjustment and HCC analytics features.
- Write user stories, use cases, process flows, and acceptance criteria with product and engineering teams.
- Analyze healthcare claims and encounter data workflows, with deep attention to diagnosis capture, HCC mapping, and RAF scoring.
- Translate CMS-HCC model logic (e.g., V28), RADV audit requirements, and encounter submission processes (RAPS/EDPS) into product specifications.




- Validate product behavior against CMS guidelines, clinical documentation standards, and coding accuracy requirements.
- Support UAT planning aligned to risk adjustment business rules and CMS model files.
- Maintain living requirement documentation and contribute to backlog grooming and roadmap discussions.

Requirements

- 4–8 years as a Business Analyst (or equivalent) in US healthcare, with a solid focus on risk adjustment for Medicare Advantage, Medicaid, and/or ACA.
- Working knowledge of CMS-HCC models, RAF scoring, HCC mapping, and the diagnosis-to-payment relationship.
- Solid understanding of healthcare claims and key domain fields — ICD-10-CM, CPT/HCPCS, claim frequency codes, place of service, dates of service, provider/rendering identifiers.
- Familiarity with 837 (encounter/claim) EDI structure and encounter data submission (RAPS/EDPS) is a strong plus.
- Understanding of healthcare payers, provider workflows, and chart/clinical documentation logic.
- Exposure to RADV audits, encounter data management, and CMS submission processes preferred.
- Comfortable in a startup setting — self-directed, proactive, strong English communication across US time zones.

📌 Clinical / Healthcare Claims Business Analyst / Product Manager (Hyderabad)
🏢 Health Data Max
📍 Hyderabad