BA

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Business Analyst – Provider Networks & Care Management

Experience: 6–10+ years (flexible based on scope)

Domain: Healthcare / Managed Care / Payer Operations

Role Overview

We are seeking an experienced Business Analyst (BA) with strong expertise in Provider Network management and Care Management programs. This role partners with clinical, network, operations, IT, and analytics teams to analyze business processes, define requirements, and support initiatives that improve clinical outcomes, operational efficiency, cost management, and regulatory compliance.

The ideal candidate has deep knowledge of healthcare payer operations, understands end to end care management workflows, and can translate business needs into clear functional and technical requirements.

Note: This position is not eligible for Immigration Sponsorship at this time

Key Responsibilities

Provider Network Analysis

• Analyze provider network operations including contracting, credentialing, directory management, network adequacy, and access standards.
• Support initiatives related to network optimization, provider performance, and value based care arrangements.
• Gather and document requirements for provider data management, directory accuracy, and compliance reporting.
• Act as a liaison between business users and technical teams for provider network systems.

Care Management & Clinical Programs

• Analyze Care Management workflows, including utilization management, case management, disease management, and population health programs.
• Support process improvements around prior authorization, referrals, transitions of care, and closure of care gaps.
• Translate clinical and operational needs into clear business and system requirements.
• Assist in the measurement and reporting of care outcomes, quality metrics, and utilization trends.

Business & Systems Analysis

• Conduct stakeholder interviews, workshops, and current state/future state process analysis.
• Develop Business Requirement Documents (BRDs), Functional Requirement Documents (FRDs), process flows, and user stories.
• Support system enhancements, integrations, and data initiatives related to provider and care management platforms.
• Validate solutions through UAT planning, execution, and defect triage.

Data, Reporting & Compliance

• Analyze healthcare data related to cost, utilization, quality, risk stratification, and provider performance.
• Support reporting for regulatory and accreditation requirements (e.g., CMS, NCQA, state mandates).
• Ensure alignment with healthcare standards such as ICD 10, CPT, HCPCS, HEDIS, and FHIR where applicable.

Required Qualifications

Experience

• 6–10+ years of experience as a Business Analyst in healthcare.
• Strong hands on experience with Provider Network operations and Care Management programs.
• Experience working with payer systems or healthcare platforms supporting network and care management functions.

Domain Knowledge

• Provider contracting, credentialing, and directory management.
• Care Management, Utilization Management, Case/Disease Management models.
• Value Based Care, ACOs, and quality improvement initiatives.
• Understanding of payer workflows and end to end member/provider lifecycle.

Technical & Functional Skills

• Requirements elicitation and documentation (BRD, FRD, user stories).
• Process modeling tools (Visio, Lucidchart, BPMN).
• Agile and/or Waterfall delivery methodologies.
• Data analysis using SQL, Excel, or BI tools (reported or self service).
• Familiarity with healthcare platforms such as care management systems, provider data systems, and claims platforms.

Soft Skills

• Strong communication skills with clinical, business, and technical stakeholders.
• Ability to translate complex clinical and operational concepts into actionable requirements.
• Analytical mindset with strong problem solving capabilities.
• Proven ability to manage multiple priorities in a fast paced environment.

Nice to Have

• Experience supporting HEDIS, Stars, Risk Adjustment, or Quality programs.
• Exposure to FHIR based integrations and healthcare interoperability initiatives.
• Certification such as CBAP, CCBA, or PMI PBA.
• Experience in payer modernization or digital health transformation initiatives.

Success Metrics

• Improved efficiency and accuracy of provider network and care management processes.
• Successful delivery of system enhancements aligned to business needs.
• Reduction in rework or defects through clear requirements and UAT support.
• Positive stakeholder feedback and measurable impact on care quality and operational outcomes.

Pay:

The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs.  The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled.  At Fractal, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case.  A reasonable estimate of the current starting base range is $180,000-$195,000.

Benefits:

As a full-time employee of the company or as an hourly employee working more than 30 hours per week, you will be eligible to participate in the health, dental, vision, life insurance, and disability plans in accordance with the plan documents, which may be amended from time to time.  You will be eligible for benefits on the first day of employment with the Company.  In addition, you are eligible to participate in the Company 401(k) Plan after 30 days of employment, in accordance with the applicable plan terms.   The Company provides for 11 paid holidays and 12 weeks of Parental Leave. We also follow a “free time” PTO policy, allowing you the flexibility to take time needed for either sick time or vacation.

Fractal provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!