Business Analyst (Healthcare)

Business Analyst Electronic Prior Authorization (ePA)

Location: Remote U.S.-Based
Job Type: Contract
Work Arrangement: Remote

Role Summary

We are seeking an experienced Business Analyst to lead and support business analysis initiatives related to Electronic Prior Authorization (ePA) and healthcare interoperability. The role will focus on supporting CMS-0057 requirements, streamlining prior authorization workflows, and enabling interoperability through FHIR-based APIs.

The ideal candidate will have strong experience in healthcare business analysis, requirements management, Agile delivery, ePA workflows, and FHIR-based interoperability. The candidate will work closely with U.S.-based business and clinical stakeholders, utilization management teams, and distributed development teams.

Key Responsibilities

• Gather, analyze, validate, and document business and functional requirements for ePA workflows and FHIR-based API requirements.
• Translate regulatory and business requirements into functional requirements, user stories, acceptance criteria, process flows, and actionable delivery plans.
• Support initiatives aligned with CMS-0057 requirements and healthcare interoperability standards.
• Facilitate collaboration among U.S.-based stakeholders, clinical/utilization management teams, product teams, and distributed development teams.
• Facilitate sprint planning, backlog refinement, requirement walkthroughs, and stakeholder discussions.
• Track delivery progress, identify risks and dependencies, and recommend corrective actions.
• Coordinate with utilization management vendors and other external/internal stakeholders as required.
• Support quality initiatives, process improvements, and operational alignment across teams.
• Create and maintain clear business documentation, workflow diagrams, process maps, and requirements documentation.
• Partner with technical teams to ensure requirements are clearly understood and translated into effective solutions.

Required Skills & Experience

• Strong experience as a Business Analyst in regulated software delivery environments.
• Hands-on experience in healthcare, preferably with Electronic Prior Authorization (ePA) and healthcare interoperability.
• Strong understanding of prior authorization workflows and healthcare data exchange.
• Experience working with CMS-0057 requirements and related prior authorization workflows.
• Experience with FHIR APIs and healthcare interoperability initiatives.
• Strong experience in requirements gathering, analysis, documentation, and management.
• Ability to create functional requirements, user stories, acceptance criteria, workflow diagrams, and process maps.
• Strong understanding of Agile/Scrum methodologies and software development lifecycle processes.
• Experience facilitating sprint planning, backlog refinement, and stakeholder communication.
• Experience with project and requirement management tools such as Jira and Azure DevOps (ADO).
• Experience collaborating with clinical, utilization management, technical, and business teams.
• Strong analytical, problem-solving, communication, and organizational skills.
• Excellent attention to detail with the ability to manage multiple priorities.
• Collaborative, proactive, and stakeholder-focused approach.

Preferred Skills

• SQL
• Python