Lead Business Analyst

Lead Business Systems Analyst – Interoperability & ePA ( electronic Prior Authorization) 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.
• 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.

• 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.

• Coordinate between:
• UM
• Medical Policy
• Clinical Teams
• Horizon API Team
• Availity
• Testing

• Coordinate end-to-end testing.
• Support CMS and BCBSA compliance readiness.

• 8+ years as BSA/Product Owner/Product Manager
• Strong facilitation and stakeholder management skills