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

Job Title

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

Engagement Type

Contract / Short-Term (Immediate Start)

Location: Remote

Duration: 8–12 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 workflows—while remaining grounded in real-world payer and provider operations.

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

1. Conceptualizing disruptive, AI-assisted workflows
2. Designing high-fidelity Figma UI/UX
3. Translating the solution into engineering-ready user stories and documentation

Key Deliverables

1. AI-Forward UX & Workflow Design

1. Design high-fidelity Figma screens that depict:
2. Provider credentialing workflows for Health Systems
3. Provider credentialing workflows for Health Plans
4. Reimagine traditional credentialing processes using:
5. AI-assisted data ingestion and normalization
6. Intelligent task prioritization and exception handling
7. Reduced manual touchpoints and “zero-click” workflows where feasible
8. Cover core and advanced use cases:
9. Initial credentialing and onboarding
10. Re-credentialing and continuous monitoring
11. Primary Source Verification (PSV)
12. Delegated credentialing
13. Exception handling, expirations, and audit readiness
14. Clearly model:
15. Human-in-the-loop vs AI-driven decisions
16. Confidence scoring, explainability, and review flows
17. Alerts, recommendations, and proactive interventions

2. Disruptive Use Case Definition

1. Identify opportunities where AI can materially change:
2. Time to credential
3. Cost per provider
4. Manual effort and rework
5. Audit and compliance burden
6. Ensure the solution:
7. Goes beyond digitizing existing workflows
8. Challenges legacy assumptions in credentialing operations
9. Differentiates clearly from incumbent credentialing platforms

3. Functional & Business Documentation

1. Produce engineering-ready artifacts, including:
2. End-to-end use cases and workflow narratives
3. User stories with clear acceptance criteria
4. Functional requirements mapped to UI and AI behaviors
5. Edge cases, fallback scenarios, and exception handling
6. Clearly document:
7. Where AI augments human decision-making
8. Where deterministic rules still apply
9. Guardrails for compliance, accuracy, and auditability

4. API, Data & Intelligence Flow Interpretation

1. Review and interpret API documentation from primary credentialing data sources (e.g., CAQH, NPI, state boards, sanctions, exclusions)
2. Identify and document:
3. Which APIs are invoked at each stage of the workflow
4. Event-driven vs on-demand data pulls
5. How AI layers consume, enrich, and reason over source data
6. Partner with engineering to ensure AI concepts are implementable, not theoretical.

Required Experience & Skills

Provider Credentialing Domain Expertise (Must-Have)

1. Deep, hands-on experience with:
2. Health System credentialing operations
3. Health Plan / payer credentialing workflows
4. Primary Source Verification (PSV)
5. Regulatory and compliance considerations
6. Prior involvement in credentialing platforms, provider data management, or payer/provider operational systems.

AI & Intelligent Systems Acumen (Must-Have)

1. Strong working knowledge of:
2. AI/ML-enabled enterprise products
3. Generative AI and intelligent automation concepts
4. Ability to:
5. Identify where AI creates real operational leverage
6. Avoid “AI for AI’s sake”
7. Design explainable, compliant, and auditable AI-assisted workflows
8. Experience collaborating with data science or AI engineering teams is a strong plus.

UX, Product & Technical Skills

1. Proven experience designing enterprise-grade UX in Figma
2. Strong product thinking—able to connect business outcomes to UX and system behavior
3. Comfortable interpreting API specifications and mapping them to workflows
4. Experience working with agile engineering teams for clean handoff

Ideal Background

1. 8+ years as a Business Analyst / Product Analyst / Product Manager in healthcare technology
2. Experience spanning:
3. Payers and provider organizations
4. Platform or product-led healthcare solutions
5. Prior exposure to AI-enabled healthcare platforms preferred

Engagement Expectations

1. Operate independently with minimal oversight
2. Drive clarity in ambiguous problem spaces
3. Balance innovation with regulatory realism
4. Deliver production-quality, future-ready artifacts

Why This Role

1. Opportunity to reshape how provider credentialing is done, not just improve it
2. High-impact engagement with clear ownership
3. Direct influence on a next-generation, AI-enabled healthcare platform