Job Title : Senior Healthcare Business Analyst Location : Remote Duration : 12+ Months Job Description : Roles and Responsibilities: 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. 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. Thanks & Regards Bhavanesh Eamani Lead Technical Recruiter PH : 9724400073 Agile Enterprise Solutions Inc. 2591 Dallas Parkway Suite 300 Frisco, TX 75034 Email: bhavanesh@aesincus.com Website: www.aesincus.com — Related