Business Analyst

Role Summary

• Lead and support business analysis for Electronic Prior Authorization (ePA) initiatives to meet CMS-0057 requirements for streamlined prior authorization workflows and healthcare interoperability.
• Translate regulatory and business requirements into clear functional requirements, user stories, acceptance criteria, and actionable delivery plans.
• Collaborate with U.S. stakeholders, clinical/utilization management teams, and distributed development teams to ensure successful project delivery.

Key Responsibilities

• Gather, analyze, and document business and functional requirements for ePA workflows and FHIR-based API implementations.
• Translate business requirements into user stories, acceptance criteria, process flows, and detailed business documentation.
• Facilitate sprint planning, backlog refinement, and stakeholder communication in an Agile environment.
• Track project progress, identify risks (including utilization management vendor dependencies), and recommend corrective actions.
• Support testing, quality assurance, process improvements, and operational alignment across cross-functional teams.
• Work closely with engineering, product, and business teams to ensure successful implementation of regulatory requirements.

Required Skills & Experience

• Strong experience as a Business Analyst in regulated healthcare software delivery environments, with a focus on Electronic Prior Authorization (ePA) and healthcare interoperability.
• Solid understanding of CMS-0057, ePA workflows, and healthcare interoperability standards.
• Hands-on experience with FHIR APIs, healthcare data exchange, and interoperability initiatives.
• Strong knowledge of Agile methodologies and the Software Development Life Cycle (SDLC).
• Experience using requirement management and project tracking tools such as Jira and Azure DevOps (ADO).
• Ability to create clear business documentation, workflow diagrams, process maps, and functional specifications.
• Excellent analytical, problem-solving, communication, and stakeholder management skills.
• Strong organizational skills with exceptional attention to detail.

Preferred Skills

• SQL
• Python
• Experience with healthcare payer systems and utilization management workflows.
• Familiarity with healthcare regulations, including HIPAA and CMS interoperability mandates.