Business Analyst with Interoperability, Authorization

Role: IT Business Analyst (Interoperability/Authorization)

Location: Remote

Duration: Contract

Job description:

The Senior IT Business Analyst (Interoperability/Authorization) acts as the primary bridge between business strategy and technical execution. You will design, validate, and implement internal healthcare data exchange solutions for our health plan. This role collaborates with Databricks development teams to transform complex clinical, medical, and regulatory policy data into actionable analytics asset while ensuring accuracy and compliance.

Core Responsibilities:

• Requirement Gathering: Identify applicable contractual requirements, obligations, policy requirements, compliance requirements, and business rules.
• Functional Specs: Map contractual and business requirements into detailed functional specifications.
• Standards Enforcement: Serve as the subject matter expert for healthcare data compliance across all internal platforms.
• Testing & Validation: Define comprehensive test scenarios, validate complex payloads, and coordinate End-to-End user acceptance testing.
• Data Collaboration: Partner with data engineers to support translating business logic into optimized PySpark or SQL transformation pipelines.

Technical Qualifications:

• BA Experience: Minimum 10+ years of IT Business Analysis experience, with at least 4 years dedicated to healthcare interoperability and authorization.
• Payer Operations: 10+ years’ experience working within a health plan environment, including deep grasp of authorization workflows.
• Interoperability Standards: 3+ years working knowledge of CMS Interoperability rules.
• Data Querying: 3+ years SQL skills to analyze large datasets, write complex joins, and audit pipeline data quality.
• EDI X12 Expertise: 3+ years’ experience with 837 (Claims), 834 (Enrollment), 835 (Remittance), and 270/271 (Eligibility) processes.
• Databricks Ecosystem: 1+ years familiarity with Delta Lake concepts, Medallion Architecture (Bronze/Silver/Gold), and Unity Catalog governance.
• Soft Skills & Professional Experience
• Agile Delivery: Proven success operating in fast-paced Scrum or Kanban environments, owning Jira epics and story decomposition.
• Bridging the Gap: Ability to explain highly complex X12 looping structures to developers, and technical Databricks limitations to business stakeholders.