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 goals—whether 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:

Bachelor's degree in Healthcare Administration, Public Health, Information Systems, Business, or related field. Master’s degree is a plus.

Experience:

3–7 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.