Senior Healthcare Business Analyst / Behavioral Health SME

Location: USA – Remote
Employment Type: W2 Contract
Contract Rate: $60/hr on W2
Salary: $150K gross salary, including 15% QPLC
Experience: 10+ Years
Domain: Healthcare Payer | Behavioral Health (BH)

Role Overview

We are seeking a seasoned Behavioral Health SME with strong Business Analysis and Healthcare Payer systems expertise to support payer transformation initiatives.

The ideal candidate will have deep knowledge of Behavioral Health operations, end-to-end payer processes, healthcare regulations, and payer technology platforms, with the ability to effectively bridge business and technology teams.

Key Requirements

• 10+ years of Healthcare Payer experience, including 5+ years of Behavioral Health experience covering Mental Health and 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 and standards, including:

  • MHPAEA (Mental Health Parity and Addiction Equity Act)

  • Medicare & Medicaid Behavioral Health programs

  • HIPAA

  • CMS and state-specific regulatory requirements

  • NCQA / URAC standards

• Strong Business Analysis skills, including:

  • Requirements gathering

  • BRD / FRD development

  • User Stories

  • Process mapping

  • Gap analysis

  • UAT / SIT support

  • Stakeholder management

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

• Knowledge of healthcare transactions and interoperability standards:

  • 837

  • 835

  • 834

  • 270/271

  • HL7 / FHIR

• Strong SQL, data analysis, and healthcare system integration experience.

Preferred Qualifications

• Experience with Commercial, Medicare, and Medicaid lines of business.

• Exposure to Behavioral Health Care Management, Utilization Management, and Value-Based Care programs.

• Experience with 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

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

Submission Requirement

Please submit suitable profiles matching the required skill set at your agreed rate card with Wipro.