Job Title

Contract Business Analyst Provider Credentialing (AI-Enabled Healthcare Platforms)

Engagement Type

Contract / Short-Term (Immediate Start)

Location: Remote

Duration: 812 weeks (estimated, based on scope)

Start: Immediate

Overview

We are seeking a highly experienced Business Analyst with deep domain expertise in Provider Credentialing and strong working knowledge of AI-enabled product design to lead a defined, outcome-driven engagement.

The objective of this role is not to design another credentialing system, but to reimagine provider credentialing using AI, automation, and intelligent workflowswhile remaining grounded in real-world payer and provider operations.

This role owns the functional vision end-to-end:

Conceptualizing disruptive, AI-assisted workflows

Designing high-fidelity Figma UI/UX

Translating the solution into engineering-ready user stories and documentation

Key Deliverables :

1. AI-Forward UX & Workflow Design

Design high-fidelity Figma screens that depict :

- Provider credentialing workflows for Health Systems

- Provider credentialing workflows for Health Plans

Reimagine traditional credentialing processes using:

- AI-assisted data ingestion and normalization

- Intelligent task prioritization and exception handling

- Reduced manual touchpoints and zero-click workflows where feasible

Cover core and advanced use cases :

Initial credentialing and onboarding

- Re-credentialing and continuous monitoring

- Primary Source Verification (PSV)

- Delegated credentialing

- Exception handling, expirations, and audit readiness

Clearly model :

- Human-in-the-loop vs AI-driven decisions

- Confidence scoring, explainability, and review flows

- Alerts, recommendations, and proactive interventions

2. Disruptive Use Case Definition

- Identify opportunities where AI can materially change:

- Time to credential

- Cost per provider

Manual effort and rework

Audit and compliance burden

Ensure the solution:

- Goes beyond digitizing existing workflows

- Challenges legacy assumptions in credentialing operations

- Differentiates clearly from incumbent credentialing platforms

3. Functional & Business Documentation

- Produce engineering-ready artifacts, including:

- End-to-end use cases and workflow narratives

- User stories with clear acceptance criteria

- Functional requirements mapped to UI and AI behaviors

- Edge cases, fallback scenarios, and exception handling

4. API, Data & Intelligence Flow Interpretation

- Review and interpret API documentation from primary credentialing data sources (e.g., CAQH, NPI, state boards, sanctions, exclusions)

Identify and document:

- Which APIs are invoked at each stage of the workflow

- Event-driven vs on-demand data pulls

- How AI layers consume, enrich, and reason over source data

- Partner with engineering to ensure AI concepts are implementable, not theoretical.

Required Experience & Skills :

Provider Credentialing Domain Expertise (Must-Have) :

Deep, hands-on experience with :

- Health System credentialing operations

- Health Plan / payer credentialing workflows

- Primary Source Verification (PSV)

- Regulatory and compliance considerations

- Prior involvement in credentialing platforms, provider data management, or payer/provider operational systems.

Ideal Background :

- 8+ years as a Business Analyst / Product Analyst / Product Manager in healthcare technology

Experience spanning:

- Payers and provider organizations

- Platform or product-led healthcare solutions

- Prior exposure to AI-enabled healthcare platforms preferred

Engagement Expectations :

- Operate independently with minimal oversight

- Drive clarity in ambiguous problem spaces

- Balance innovation with regulatory realism

- Deliver production-quality, future-ready artifacts

Why This Role :

- Opportunity to reshape how provider credentialing is done, not just improve it

- High-impact engagement with clear ownership

- Direct influence on a next-generation, AI-enabled healthcare platform