- Lead and support business analysis for electronic prior authorization (ePA) delivery to meet CMS 0057 requirements for streamlined PA workflows and interoperability.
- Translate regulatory and business needs into clear requirements, user stories, and actionable plans.
- Facilitate collaboration and communication between U.S. stakeholders, clinical/UM teams, and distributed development teams. Key Responsibilities:
- Gather, analyze, and document business and functional requirements for ePA workflows and FHIR based API obligations.
- Translate requirements into user stories, acceptance criteria, and process flows.
- Facilitate sprint planning, backlog refinement, and stakeholder communication.
- Track delivery progress, identify risks (including UM vendor coordination), and recommend corrective actions
- Support quality, process improvements, and operational alignment.
Technical Skills & Tools
- Business analysis in regulated software delivery focused on ePA and interoperability.
- Strong understanding of Agile methodologies.
- Experience with requirement and project tracking tools (e.g., Jira, ADo).
- Ability to create clear documentation and workflow diagrams. SQL, Python
Desired Attributes:
- Strong analytical and problem-solving skills
- Clear communication with technical and business teams
- High attention to detail and organization
- Collaborative and proactive mindset
Key Activities:
Requirements Definition : Define and translate CMS-0057 ePA requirements such as FHIR-based Prior Authorization API elements, mandated response timelines ( 72 hrs expedited; 7 days standard), and structured denial reasons for payer systems
PA Workflow & UM Integration Analyze current PA processes with Utilization Management teams and UM vendors, map gaps, and document requirements for automated ePA submission, status updates, and decision workflows.
ePA Solution Translation & Planning : Convert regulatory and operational needs into user stories, acceptance criteria, and workflow diagrams that guide development of payer ePA APIs, internal systems, and provider interfaces.
Delivery & Implementation : Collaborate with cross-functional teams to monitor ePA development, manage UM vendor/API dependencies, validate deliverables against CMS timelines and support payer compliance reporting.