Healthcare Interoperability Business Systems Analyst Lead

AmeriHealth Caritas is a mission-driven organization with over 30 years of experience in delivering comprehensive healthcare solutions. They are seeking a Lead Business Systems Analyst to drive business analysis and data exchange initiatives, focusing on HL7 standards to ensure regulatory compliance and data integrity.

Responsibilities:

• Lead requirements end to end, independently driving discovery, analysis, and solution definition across business and IT stakeholders
• Serve as a subject matter expert on CMS Interoperability and HL7 exchange protocols, including FHIR, CCDs, ADTs, etc
• Perform hands on data analysis using SQL, Databricks, and related tools to validate data, troubleshoot issues, and support design decisions
• Document business and technical requirements, source to target mappings, data specifications, business rules, and process flows
• Support validation and QA by reviewing data outputs, test cases, and results to ensure accuracy and compliance
• Collaborate with internal teams and external partners with minimal supervision to gather requirements, drive key decisions, and support successful implementations
• Mentor and guide junior BAs on best practices in requirements, documentation, analysis, and stakeholder engagement
• Communicate business and process solutions, recommendations, and issues to ACFC management on a regular basis
• Document all business process flows related to interoperability initiatives
• Apply working knowledge of ACFC Managed Care functions (HealthCare Services, Claims, Enrollment, Quality/HEDIS, Risk Adjustment, Care Management, Utilization Management) to support problem solving and solution design
• Provide strong communication and status updates to business and IT stakeholders and management
• Build consensus among users, IT, and senior leadership on business problems and solution approaches
• Address most inquiries independently, escalating only when appropriate
• Ensure requests are addressed promptly, professionally, and with persistence in gathering required information
• Meet with external vendors to evaluate products and ensure ACFC requirements are met
• Communicate effectively with senior and mid level management
• Understand chain of command, decision making roles, and communicate accordingly
• Demonstrate strong analytical and problem solving skills, including evaluating alternatives, recommending solutions, and articulating impacts
• Make sound decisions with minimal direction and apply appropriate approaches to each situation
• Respond promptly to requests related to budgets, operational objectives, reporting, process re engineering, and business flows
• Produce clear, well structured written and verbal communications
• Brief management appropriately when issues require senior level attention
• Maintain regular communication with management and keep staff informed of progress, risks, and priorities

Requirements:

• At least five to ten (5 – 10) years of experience in healthcare IT, data integration, or business analysis
• Experience with FHIR, HL7 clinical data exchange standards (CCD/ADT/SIU) and healthcare terminology (LOINC, ICD 10, CPT, etc.)
• Ability to interpret large datasets and deliver evidence based recommendations
• Strong organizational, analytical, and interpersonal skills
• Ability to communicate effectively at all organizational levels
• Advanced proficiency with Microsoft Office Suite
• Proficiency in SQL, Databricks, and data validation techniques
• Experience in Agile Delivery with usage of tools like Azure DevOps or JIRA
• General knowledge of healthcare operations (HEDIS, Prior Authorizations, etc.) in a managed care environment
• Demonstrated ability to work independently and collaboratively
• Strong documentation, communication, and problem solving skills
• Bachelor's degree or equivalent experience