About this role
Role Overview
- Spearhead business analysis efforts on complex projects.
- Guide a team of business analysts to elicit, analyze, and document business requirements.
- Collaborate with project managers, technical teams, and business stakeholders.
- Lead requirement gathering sessions and oversee documentation quality.
- Mentor junior analysts and ensure adherence to best practices throughout the project lifecycle.
- Bridge the gap between business needs and technical solutions.
- Drive process improvements and deliver high-quality business outcomes.
Requirements
- Analyze CMS-0057-F Final Rule and related CMS guidance to identify mandatory payer obligations, timelines, and reporting requirements.
- Break down regulatory text into clear business requirements, functional requirements, and acceptance criteria.
- Trace CMS requirements to FHIR API capabilities, UM workflows, and Atrezzo system features.
- Maintain regulatory traceability matrix (RTM) linking CMS clauses to system requirements.
- Define and document requirements for:
- FHIR R4 resources (e.g., Coverage, Claim, ClaimResponse, PriorAuthorization, Questionnaire, DocumentReference).
- Patient Access API, Provider Access API, and Payer-to-Payer API impacts relevant to CMS-0057-F.
- FHIR-based Prior Authorization APIs (including decisions, status, attachments, and clinical documentation exchange).
- Collaborate with architects and developers to ensure FHIR implementation aligns with CMS specifications and industry IGs (e.g., CARIN, Da Vinci).
- Translate business needs into API-level user stories, data mappings, and workflow diagrams.
- Act as the functional 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 existing UM functionality and CMS-0057-F requirements.
- Define configuration vs. customization requirements within ANG UM
Benefits
- Competitive Salary
- Excellent career development opportunities