What are the responsibilities and job description for the Lead Business Analyst position at TechDoQuest?
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.
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
Salary : $55 - $65