Behavioral Health SME​/Sr. Business Analyst

Role:
Senior Healthcare Business Analyst / Behavioral Health SME

Location:

Remote - USA Type:
Contract/FTE

Seeking a seasoned Behavioral Health SME with strong Business Analyst and healthcare systems expertise to support payer transformation initiatives. The ideal candidate will have deep knowledge of Behavioral Health operations, end-to-end payer processes, and healthcare regulations, along with the ability to bridge business and technology teams.

• 10+ years of Healthcare Payer experience with 5+ years in Behavioral Health (Mental Health & Substance Use Disorders).
• Strong understanding of the end-to-end payer lifecycle
  :
• Eligibility & Enrollment
• Benefits Configuration
• Claims Processing & Adjudication
• Prior Authorization
• Care & Case Management
• Provider Management
• Payment Integrity
• Deep knowledge of Behavioral Health regulations
  , including:
• MHPAEA (Mental Health Parity)
• HIPAA
• CMS and State-specific regulatory requirements
• NCQA/URAC standards
• Strong Business Analysis skills:
• Requirements gathering
• BRD/FRD/User Stories
• Process mapping
• Gap analysis
• UAT/SIT support
• Experience with payer platforms such as Facets, QNXT, Health Rules, Guiding Care, Tru Care, or similar
  .
• Knowledge of healthcare transactions and interoperability standards:
• 837, 835, 834, 270/271
• HL7/FHIR
• Strong SQL, data analysis, and system integration understanding.

• Experience with Commercial, Medicare, and Medicaid lines of business.
• Exposure to Behavioral Health care management, utilization management, and value-based care programs.
• Experience working on payer modernization,
  data, AI
  , or digital transformation initiatives.