Lead Business Analyst responsible for guiding analysis efforts, mentoring junior analysts, and ensuring project alignment with business and regulatory requirements, focusing on CMS-0057-F.
ProArch is seeking an experienced Lead Business Analyst to spearhead business analysis efforts on complex projects. In this leadership role, you will guide a team of business analysts to elicit, analyze, and document business requirements, ensuring alignment with organizational goals and stakeholder needs. You will collaborate with project managers, technical teams, and business stakeholders to facilitate communication and drive project success.
Responsibilities include leading requirement gathering sessions, overseeing documentation quality, mentoring junior analysts, and ensuring adherence to best practices throughout the project lifecycle. Your role is critical in bridging the gap between business needs and technical solutions, driving process improvements and delivering high-quality business outcomes.
Requirements
- Analyze CMS-0057-F Final Rule and related CMS guidance to identify mandatory payer obligations, timelines, and reporting requirements.
- Break down regulatory text into clear business requirements, functional requirements, and acceptance criteria.
- Trace CMS requirements to FHIR API capabilities, UM workflows, and Atrezzo system features.
- Maintain regulatory traceability matrix (RTM) linking CMS clauses to system requirements.
- Define and document requirements for:
- FHIR R4 resources (e.g., Coverage, Claim, ClaimResponse, PriorAuthorization, Questionnaire, DocumentReference).
- Patient Access API, Provider Access API, and Payer-to-Payer API impacts relevant to CMS-0057-F.
- FHIR-based Prior Authorization APIs (including decisions, status, attachments, and clinical documentation exchange).
- Collaborate with architects and developers to ensure FHIR implementation aligns with CMS specifications and industry IGs (e.g., CARIN, Da Vinci).
- Translate business needs into API-level user stories, data mappings, and workflow diagrams.
- Act as the functional SME for Utilization Management (UM) within ANg/Atrezzo.
- Document current-state and future-state UM workflows, including:
- Prior authorization intake
- Medical necessity review
- Decision rendering
- Notifications and status updates
- Identify system gaps between existing UM functionality and CMS-0057-F requirements.
- Define configuration vs. customization requirements within ANG UM
Benefits
- Competitive Salary
- Excellent career development opportunities
Top Skills
APIs
Cms Regulations
Fhir
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