Top 27 Analyst crd Jobs

Lead Business Systems Analyst – Interoperability & Electronic Prior Authorization (ePA)
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Charles River IMS Support Analyst, L&G - Asset Management, America
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San Jose/Evergreen Community College District —San Jose, CA
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Charles River IMS Support Analyst, L&G - Asset Management, America
LegalAndGeneral —Chicago, IL
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Sales Operations Analyst 1
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Senior Compliance Analyst
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State Street —Burlington, MA
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Systems Analyst, AVP
State Street —Burlington, MA
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Target Analyst Reporter (Bluffdale/Draper, Utah)
Clear Ridge Defense —Bluffdale, UT
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Lead Analyst, Supply Chain Planning
Analog Devices —Wilmington, MA
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11d
Senior Business Analyst
State Street —Burlington, MA
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Lead Business Systems Analyst – Interoperability & Electronic Prior Authorization (ePA)

Hiring Street
Newark, NY

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Job Details

Contract
$55 - $75 an hour

Benefits

401(k)

Qualifications

Application Integration
Vendor relationship building
Systems integration
Overseeing health insurance pre-certification
Bachelor's degree
Vendor performance improvement
User acceptance testing
Vendor relationship management
Requirements management
Business Administration
Project stakeholder communication
Stakeholder relationship building
Business process modeling
Stakeholder management

Full Job Description

Position Name: Lead Business Systems Analyst – Interoperability & Electronic Prior Authorization (ePA)

Location: Newark, NJ

Client: Leading U.S. Healthcare Enterprise

Work Schedule: 3 days/week from office

Description

We are seeking an experienced Lead Business Systems Analyst (BSA) to drive business analysis, requirements management, and stakeholder coordination for healthcare interoperability and Electronic Prior Authorization (ePA) initiatives. This role will serve as the primary liaison between business, technology, vendor, and operational teams to ensure successful implementation of CMS interoperability mandates and prior authorization workflows, including CRD (Coverage Requirements Discovery), DTR (Documentation Templates and Rules), PAS (Prior Authorization Support), Patient Access, Provider Access, and Payer-to-Payer solutions.

The ideal candidate will possess deep healthcare payer experience, strong business analysis expertise, vendor management skills, and a solid understanding of API integrations and interoperability frameworks.

Role and Responsibilities

Requirements Leadership:

Own and manage end-to-end business and functional requirements for interoperability and ePA initiatives, including CRD, DTR, and PAS implementations.
Lead requirements gathering sessions with business, operations, clinical, and technology stakeholders.
Translate regulatory mandates, business needs, and operational processes into detailed business and technical requirements.
Maintain complete requirements traceability from CMS regulations through design, development, testing, and implementation.
Create and manage business process flows, use cases, user stories, and functional specifications.

Vendor Management

Serve as the primary day-to-day requirements lead and liaison with external vendors, including Availity and other implementation partners.
Review and validate vendor assumptions, solution designs, workflows, and implementation approaches.
Identify and track project gaps, risks, dependencies, issues, and key decisions.
Ensure vendor deliverables align with business objectives, compliance requirements, and implementation timelines.

FHIR & Interoperability Analysis

Analyze and support interoperability workflows related to:
Coverage Requirements Discovery (CRD)
Documentation Templates and Rules (DTR)
Prior Authorization Support (PAS)
Patient Access APIs
Provider Access APIs
Payer-to-Payer Data Exchange
Understand FHIR-based data exchange requirements and associated resource mappings.
Collaborate with API and integration teams to assess business process impacts and implementation requirements.
Support interoperability solution design discussions and requirements validation.

Cross-Functional Coordination

Coordinate and collaborate across multiple business and technology teams, including:

Utilization Management (UM)
Medical Policy
Clinical Operations Teams
API Development Teams
Vendor Partners (Availity, Cognizant, Prime, etc.)
Enterprise Architecture
Quality Assurance and Testing Teams
Program and Project Management stakeholders

Testing & Implementation Readiness

Define business test scenarios, acceptance criteria, and validation requirements.
Coordinate end-to-end testing activities across multiple systems and teams.
Validate provider and member workflows to ensure business readiness.
Support CMS interoperability compliance and regulatory readiness efforts.
Participate in User Acceptance Testing (UAT) and implementation planning activities.

Core Skills & Qualifications

Must-Have Experience

8+ years of experience as a:
Business Systems Analyst (BSA), or
Product Owner, or
Product Manager
Strong healthcare payer industry experience.
Hands-on experience with Prior Authorization processes and workflows.
Experience managing and coordinating third-party vendors and implementation partners.
Experience with API integrations and system integration projects.
Excellent requirements elicitation, facilitation, and stakeholder management skills.
Strong analytical, problem-solving, and communication abilities.

Highly Preferred Qualifications

Experience with FHIR (Fast Healthcare Interoperability Resources).
Knowledge of CMS-0057-F interoperability regulations.
Experience implementing or supporting CRD, DTR, and PAS workflows.
Knowledge of HL7 standards.
Experience with healthcare interoperability programs and initiatives.
Understanding of Utilization Management (UM) workflows.
Familiarity with Medical Policy systems and processes.
Experience working with healthcare APIs and digital healthcare ecosystems.

Preferred Qualifications

Regulatory compliance analysis and requirements management.
Healthcare interoperability and data exchange standards.
Business process modeling and workflow analysis.
Agile/Scrum delivery methodologies.
Cross-functional leadership and stakeholder engagement.
Risk, issue, and dependency management.
End-to-end testing coordination and business validation.

Education

· Bachelor’s degree in Business, Healthcare Administration, Information Systems, Computer Science, or a related field.

· Relevant healthcare, business analysis, or interoperability certifications are a plus.

Pay: $55.00 - $75.00 per hour

Benefits:

401(k)

Work Location: Hybrid remote in Newark, NY 14513

Quick Apply

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