Overview
Skills
Job Details
About the Role:
We are seeking a Strategic Consultant Business Analyst with deep expertise in CMS Interoperability mandates and Medicaid programs. This is not a traditional BA role focused on BRDs and IT documentation—this role requires someone who can interpret federal regulations, perform impact analysis, and deliver executive-level insights that shape program strategy.
The ideal candidate will bring consulting experience, strong leadership presence, and the ability to engage with senior executives and challenging stakeholders.
Key Responsibilities:
Analyze and interpret CMS Interoperability & Prior Authorization mandates.
Conduct gap assessments of business processes and systems against CMS rules.
Provide executive-level insights, impact assessments, and roadmaps.
Act as a trusted advisor to program leadership, influencing compliance strategy.
Facilitate discussions with business owners, IT teams, and executive stakeholders.
Leverage strong knowledge of FHIR, ASC X12, and healthcare data exchange.
Track CMS timelines and support compliance readiness planning.
Qualifications:
7+ years’ experience as a Business Analyst or Consultant in healthcare IT, payer/provider, or government programs.
Proven experience engaging with executives and handling tough clients.
Strong knowledge of HL7 FHIR standards and CMS interoperability mandates.
Medicaid program experience required; Medicare knowledge a plus.
Excellent communication, facilitation, and leadership presence.
Strong consulting mindset with ability to turn regulations into actionable strategies.
Preferred:
Experience with health plans, managed care, or state Medicaid agencies.
Familiarity with claims, prior authorization, and EHR systems.
Understanding of API frameworks and data mapping.
Location: Remote (U.S.)
Duration: Long-term Contract