Job Summary

As a Senior Healthcare Business Analyst - Revenue Cycle Management, you will be a part of a team to build and test clinical quality measures published by NCQA/CMS with yearly upgrades.

Responsibilities

- Translate business needs into structured documentation, support product increments, ensure compliance with HIPAA/CMS/NSA guidelines, and work with stakeholders to drive adoption of recommended changes.

- Serve as SME for following (One or more) - Scheduling/Registration, Eligibility Benefits, Authorization (278), Coding/CDI, Claim Edits, Payment Posting, Denials Appeals, Underpayment management, AR follow-up, and Revenue Integrity.

- Define and monitor RCM KPIs.

- Interpret and apply payer policies, LCD/NCD guidelines, NCCI edits, and E/M coding standards, business analysis and requirements management.

- Produce structured deliverables including BRDs, FSDs, user stories, acceptance criteria, traceability matrices, UAT plans, RACIs, SOPs, and training materials.

- Support end-to-end requirements traceability and ensure alignment between business and technical teams.

- Contribute to product visioning, roadmap development, and release planning.

- Prioritize and refine backlogs in Jira/ADO based on business value and dependencies and work with engineering, QA, and data/AI teams to ensure solution clarity and feasibility.

Experience

- 8 - 10 Years

Location

- Mumbai

Educational Qualifications

- Engineering Degree - BE/ME/BTech/MTech/BSc/MSc.

- Technical certification in multiple technologies is desirable.

Skills

Mandatory Technical Skills

- Must have worked on at least one EHR product (Epic / Cerner / Allscripts / e-clinical works/McKesson) and Electronic Data Interchange (EDI) data sets





- Able to derive high impact use cases with good understanding of digital technologies (AI/ML/Analytics/Gen AI/ Automation) and industry trends

- Help Clients innovate and grow with potential opportunity savings identified

- Assess the impact of regulatory changes like pricing transparency on overall RCM processes

- Identify opportunities for process optimization, areas of improvement and efficiency improvements within the systems

- Excellent communication and interpersonal skills for effective collaboration with clients

- Demonstrate problem-solving abilities and strategic thinking to drive continuous improvement in client system and applications

- Should have innovative skills to adapt and create solution as per customer requirement, and create service offerings/solutions in identified areas

- Track latest developments in domain, competitors and healthcare technology developments.

- Lead one or more accounts and consulting teams to ensure Customer Success, in a billable role, develop relationships with customer business sponsors, demonstrate CitiusTech consulting and domain leadership with transformative approach

Good to Have Skills

- Must have experience in clinical data systems, EHR systems

- Knowledge of denials data, Edits and scrubbing

- Strong understanding of data collection methodologies and regulatory requirements (HFMA)

- Ability to understand the client problem statement and solid analytical skills for identifying the possible solution

- Proven experience as a Business Analyst in major areas within RCM

- Proactive, adaptable to change with the ability to envision the final work product

Disclaimer: This job posting and Location has been aggregated from external source. Role details, content, and availability are subject to change. Applicants are advised to confirm the latest information directly on the company website before applying.

📌 Sr Healthcare BA - I_Healthcare Business Analysis/Consulting (Navi Mumbai)
🏢 CitiusTech
📍 Navi Mumbai