Business Analyst

Role: Senior Business Analyst

Location: Remote USA

Seeking a Senior Business Analyst with strong experience in US Healthcare Payer, CMS Interoperability, and ONC Mandates, specifically focused on Patient Access API implementations. The role involves gathering requirements, managing healthcare data integration, ensuring regulatory compliance, and supporting interoperability initiatives.

Duties:

• Gather and document business and functional requirements for CMS Interoperability initiatives.
• Lead requirement analysis for Patient Access API projects.
• Work with business and technical teams to define member, claims, provider, and clinical data requirements.
• Analyze historical healthcare data and support data mapping activities.
• Create business process flows, user stories, BRDs, FRDs, and acceptance criteria.
• Facilitate stakeholder meetings and requirement workshops.
• Support UAT planning, testing, and defect resolution.
• Ensure compliance with CMS, ONC, FHIR, and interoperability standards.
• Collaborate with architects and developers on API integrations and data transformation requirements.

Required:

• Min 8+ years of Business Analyst experience in the US Healthcare Payer domain.
• Hands-on experience with CMS Interoperability and ONC Mandates.
• Experience implementing or supporting Patient Access APIs.
• Strong knowledge of healthcare data, including:
  • Claims
  • Clinical
  • Eligibility
  • Member data
• Knowledge of FHIR, HL7, and REST APIs.
• Strong requirements gathering, documentation, and stakeholder management skills.
• Experience in creating User Stories, BRDs, FRDs, and Acceptance Criteria.
• Understanding of healthcare regulatory compliance requirements.

Desired:

• Experience with:
  • Provider Access API
  • Payer-to-Payer Data Exchange
  • Prior Authorization initiatives
• Experience working in Agile/Scrum environments.
• Exposure to healthcare data platforms and cloud technologies.
• Strong communication and client-facing skills.