Lead Business Analyst

This is a fully remote position, open to applicants in India.

📋 Description

• Lead business analysis initiatives on intricate projects.

• Direct a team of business analysts to gather, analyze, and document business requirements.

• Collaborate with project managers, technical teams, and business stakeholders.

• Facilitate requirement gathering sessions and ensure the quality of documentation.

• Mentor junior analysts and promote adherence to best practices throughout the project lifecycle.

• Serve as a liaison between business needs and technical solutions.

• Propel process enhancements and achieve high-quality business results.

⛳️ Requirements

• Analyze CMS-0057-F Final Rule and associated CMS guidance to determine mandatory payer obligations, timelines, and reporting requirements.

• Deconstruct regulatory text into clear business requirements, functional requirements, and acceptance criteria.

• Link CMS requirements to FHIR API capabilities, UM workflows, and features of the Atrezzo system.

• Maintain a regulatory traceability matrix (RTM) connecting CMS clauses to system requirements.

• Define and document requirements for:

• FHIR R4 resources (e.g., Coverage, Claim, ClaimResponse, PriorAuthorization, Questionnaire, DocumentReference).

• Impacts related to the Patient Access API, Provider Access API, and Payer-to-Payer API concerning CMS-0057-F.

• FHIR-based Prior Authorization APIs (covering decisions, status, attachments, and clinical documentation exchange).

• Work with architects and developers to ensure FHIR implementation aligns with CMS specifications and industry IGs (e.g., CARIN, Da Vinci).

• Convert business needs into API-level user stories, data mappings, and workflow diagrams.

• Act as the functional subject matter expert (SME) for Utilization Management (UM) within ANg/Atrezzo.

• Document current-state and future-state UM workflows, including:

• Prior authorization intake.

• Medical necessity review.

• Decision rendering.

• Notifications and status updates.

• Identify system gaps between current UM functionality and CMS-0057-F requirements.

• Define configuration versus customization requirements within ANG UM.

🏝️ Benefits

• Competitive Salary

• Excellent career development opportunities