Healthcare Business Analyst / Behavioral Health SME

Job Title: Senior Healthcare Business Analyst / Behavioral Health SME

Experience: 10+ Years

Domain: Healthcare Payer | Behavioral Health (BH)

Role Overview

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.

Key Requirements

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

Appeals & Grievances

Payment Integrity

Deep knowledge of Behavioral Health regulations, including:

MHPAEA (Mental Health Parity)

Medicare & Medicaid BH programs

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

Stakeholder management

Experience with payer platforms such as Facets, QNXT, HealthRules, GuidingCare, TruCare, or similar.

Knowledge of healthcare transactions and interoperability standards:

837, 835, 834, 270/271

HL7/FHIR

Strong SQL, data analysis, and system integration understanding.

Preferred

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.

Ideal Candidate

The ideal candidate will be a Behavioral Health payer SME who combines deep business process knowledge, regulatory expertise, system knowledge, and business analysis skills, with proven experience across:

Behavioral Health + Claims + Eligibility + Benefits + Care Management + Provider Operations + Regulatory Compliance + Payer Technology Platforms.

This person should be capable of driving both strategic business discussions and detailed system-level solution design discussions with equal effectiveness.