Healthcare Business Analyst (AI & Automation)

Provident Healthcare Consulting operates skilled nursing, behavioral health, and substance use disorder treatment services across the Midwest. The Healthcare Business Analyst will bridge clinical and back-office operations with software engineering by mapping workflows, documenting requirements, identifying automation opportunities, and validating AI-powered solutions. The role also facilitates stakeholder interviews and UAT while ensuring healthcare, compliance, and operational requirements are accurately translated into technical deliverables.

Responsibilities:

• Map current-state workflows end to end — clinical and back-office — through structured stakeholder interviews
• Produce swim-lane diagrams showing role, system, and decision gate at every step
• Document every provider-payer touchpoint: eligibility, prior authorization, concurrent review, reauthorization, denial and appeal
• Find and quantify redundant data entry — staff hours, error rate, compliance exposure
• Build the business case for every automation opportunity, including the cost of doing nothing
• Prioritize every opportunity on a value-vs-complexity matrix that spans all business functions, not just the loudest one
• Turn operational pain points from back-office staff into formal use cases with measurable success criteria
• Define the canonical data model every source must normalize to before it writes to the system of record
• Classify regulated vs. non-regulated data at every step of every flow, and document the consent and handling requirements attached to each
• Author the Software Requirements Specification — functional and non-functional, with scope boundaries drawn explicitly — alongside the Architect and the CTO, and hold traceability from SRS through SDS into test cases
• Pressure-test the Human-in-the-Loop approval design against operational reality — and say so when it doesn't survive contact
• Design and facilitate UAT with clinical and administrative staff, and validate AI extraction accuracy against ground truth
• Present business cases to the CTO and executive leadership in plain language, with the data behind them
• Surface blockers, requirement conflicts, and process changes before they become technical problems — across every function, not just your favorite one

Requirements:

• Three or more years inside a healthcare operation
• You have authored a formal requirements document that engineers built from. SRS, BRD, or functional spec, with structured use cases and testable acceptance criteria
• You have mapped and documented at least two back-office business functions — RCM plus at least one of HR, finance, compliance, or facility operations — to the field level, not the flowchart level
• Exceptional written communication — unambiguous requirements, clear business cases, concise executive summaries
• Strong facilitation — you can pull precise process detail out of a charge nurse and out of an AP clerk, and you know those are different conversations
• You can explain deduplication, LLM extraction, and Human-in-the-Loop to someone in any function without making them feel small
• You can carry clinical and back-office constraints back to a technical team intact
• Ability to build a quantified business case: current-state cost, projected benefit, and the rationale for where it sits in the queue
• Working command of the insurance authorization cycle end to end
• Professional swim-lane and field-level data flow diagrams (draw.io, Visio, or equivalent)
• Ability to read API documentation, JSON payloads, and data schemas — you do not need to write code
• UAT design and facilitation with non-technical users across multiple functions
• HIPAA Privacy and Security Rules, and the handling requirements that follow from them
• EMR or health information systems experience in a clinical or operational context
• Microsoft 365 fluency — Teams, SharePoint, Word, Excel, Visio or PowerPoint
• You already use AI tools to produce documentation and diagrams faster than you did two years ago
• Behavioral health, mental health, or SUD treatment settings
• Familiarity with AI and LLM concepts, enough to judge whether an extraction output is operationally accurate and not merely plausible
• Experience across multiple back-office functions in healthcare, ideally RCM plus HR, finance, or compliance
• Agile sprint work alongside developers or data engineers
• FHIR R4 and payer API integration
• CBAP or PMI-PBA
• SDLC documentation depth (SRS, SDS, STS, Run Book)
• Revenue cycle, healthcare finance, or back-office process improvement background