Sr Partners

Job Title: Lead Business Systems Analyst Interoperability & ePA ( electronic Prior Authorization)

Location: Newark, NJ -Hybrid

Mode of Hire: Contract

Job Description:

Primary Responsibilities:

Requirements Leadership:

• Own end-to-end business and functional requirements for ePA, CRD, DTR, and PAS.
• Facilitate requirement sessions across business, operations, and technology teams.
• Translate regulatory requirements into business and technical requirements.
• Maintain requirements traceability from CMS regulations through implementation and testing.

Vendor Management:

• Act as primary day-to-day requirements lead with Availity.
• Review vendor assumptions, solution designs, workflows, and implementation approaches.
• Track gaps, risks, dependencies, and open decisions.

FHIR & Interoperability Analysis:

• Understand CRD, DTR, PAS, Patient Access, Provider Access, and Payer-to-Payer workflows.
• Analyze FHIR resource requirements and data mapping needs.
• Partner with API teams on business workflow impacts.

Cross-Team Coordination:

• Coordinate between:
  • UM
  • Medical Policy
  • Clinical Teams
  • Horizon API Team
  • Availity
  • Cognizant
  • Prime
  • Enterprise Architecture
  • Testing

Testing & Readiness:

• Define business test scenarios.
• Coordinate end-to-end testing.
• Validate provider workflows.
• Support CMS and BCBSA compliance readiness.

Required Experience: Must Have:

• 8+ years as BSA/Product Owner/Product Manager
• Healthcare payer experience
• Prior Authorization experience
• Vendor management experience
• API integration experience
• Strong facilitation and stakeholder management skills

Highly Preferred:

• FHIR
• CMS-0057-F
• CRD/DTR/PAS
• HL7
• Interoperability programs
• Utilization Management workflows
• Medical Policy systems