Lead Business Analyst

2 weeks, 6 days ago
Contract
Lead
Data Science and Analytics
ProArch

ProArch

At ProArch, we help our clients accelerate growth and mitigate risk with IT services, cybersecurity services, application development, cloud computing, and data analytics. ProArch was founded on the belief that a future where change is ‘business as usu...

Internet Software & Services
251-1K
Founded 2006

Description

  • Lead business analysis activities for complex projects and guide a team of business analysts.
  • Elicit, analyze, and document business requirements, functional requirements, and acceptance criteria.
  • Lead requirement-gathering sessions with stakeholders and project teams.
  • Oversee the quality and consistency of requirements documentation and traceability artifacts.
  • Mentor and support junior analysts throughout the project lifecycle.
  • Collaborate with project managers, technical teams, architects, and business stakeholders to drive project success.
  • Translate CMS-0057-F Final Rule and related guidance into actionable business and system requirements.
  • Maintain a regulatory traceability matrix linking CMS clauses to system requirements.
  • Define and document current-state and future-state utilization management workflows.
  • Identify system gaps and determine configuration versus customization needs within ANG UM.

Requirements

  • Experience analyzing CMS-0057-F Final Rule and related CMS guidance.
  • Ability to break regulatory text into business requirements, functional requirements, and acceptance criteria.
  • Experience tracing regulatory requirements to FHIR API capabilities, UM workflows, and system features.
  • Experience maintaining a regulatory traceability matrix (RTM).
  • Knowledge of FHIR R4 resources, including Coverage, Claim, ClaimResponse, PriorAuthorization, Questionnaire, and DocumentReference.
  • Experience with Patient Access API, Provider Access API, and Payer-to-Payer API requirements.
  • Knowledge of FHIR-based Prior Authorization APIs, including decisions, status, attachments, and clinical documentation exchange.
  • Experience collaborating with architects and developers to align implementation with CMS specifications and industry implementation guides such as CARIN and Da Vinci.
  • Ability to translate business needs into API-level user stories, data mappings, and workflow diagrams.
  • Experience as a functional SME for Utilization Management (UM) within ANg/Atrezzo, including prior authorization intake, medical necessity review, decision rendering, and notifications.

Benefits

  • Competitive salary.
  • Excellent career development opportunities.

Interested in this position?

Apply directly on the company website

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