InterOp BSA

Business Systems Analyst – Interoperability & ePA

Type: Contract to Hire
Location: 2 days consecutively per month onsite. Flexibility may be available for exceptional candidates.

Primary Responsibilities

Requirements Leadership

• Requirements ownership — Own end to end business and functional requirements for ePA, CRD, DTR, and Client.

• Requirements facilitation — Lead requirement discussions across business, operations, and technology teams.

• Regulatory translation — Convert regulatory mandates into clear business and technical requirements.

• Traceability management — Maintain full traceability from CMS regulations through implementation and testing.

Vendor Management

• Vendor requirements leadership — Serve as the primary day to day requirements lead with Availity.

• Vendor review — Evaluate vendor assumptions, solution designs, workflows, and implementation approaches.

• Risk and dependency tracking — Monitor gaps, risks, dependencies, and outstanding decisions.

FHIR & Interoperability Analysis

• Workflow understanding — Understand CRD, DTR, Client, Patient Access, Provider Access, and Payer to Payer workflows.

• FHIR analysis — Assess FHIR resource needs and data mapping requirements.

• API collaboration — Work with API teams to evaluate business workflow impacts.

Cross Team Coordination

• Cross functional coordination — Coordinate across UM, Medical Policy, Clinical Teams, API teams, Availity, Cognizant, Prime, Enterprise Architecture, and Testing.

Testing & Readiness

• Test scenario definition — Develop business test scenarios.

• Testing coordination — Oversee end to end testing activities.

• Workflow validation — Validate provider workflows.

• Compliance readiness — Support CMS and BCBSA compliance readiness efforts.

Required Experience

Must Have

• 8+ years as BSA, Product Owner, or Product Manager

• Healthcare payer experience

• Prior Authorization experience

• Vendor management experience

• API integration experience

• Strong facilitation and stakeholder management skills

Highly Preferred

• FHIR

• CMS 0057 F

• CRD/DTR/Client

• HL7

• Interoperability programs

• Utilization Management workflows

• Medical Policy systems