Healthcare Business Analyst

Role Summary

We are seeking an experienced Healthcare Business Analyst with strong hands-on experience in Electronic Prior Authorization (ePA), CMS-0057, FHIR, and healthcare interoperability. The candidate should be able to work directly with clients, partners, product, and technical teams and contribute quickly to complex healthcare implementations.

Key Responsibilities

• Gather, analyze, and document business and functional requirements for ePA and FHIR-based solutions.
• Support CMS-0057 requirements, including Patient Access, Provider Access, Payer-to-Payer, and Prior Authorization APIs.
• Understand end-to-end ePA workflows, including CRD, DTR, and PAS, and how Onyx workflows fit into the process.
• Read and interpret FHIR Implementation Guides, including Da Vinci, CARIN, and PDex.
• Convert business scenarios into BRDs, functional requirements, user stories, acceptance criteria, workflow diagrams, and UAT scenarios.
• Work with clients, healthcare partners, product, development, and QA teams to clarify requirements and drive decisions.
• Participate in Agile ceremonies including backlog refinement, sprint planning, and requirement walkthroughs.

Required Skills

• 5+ years of experience as a Healthcare Business Analyst.
• Hands-on ePA / Prior Authorization experience.
• Strong understanding of CMS-0057 and Prior Authorization APIs.
• Strong working knowledge of FHIR, HL7, and healthcare interoperability.
• Experience with CRD, DTR, and PAS.
• Ability to work with FHIR Implementation Guides Da Vinci, CARIN, PDex.
• Understanding of healthcare code sets/terminologies.
• Strong experience creating BRDs, requirements, user stories, UAT scenarios, and process flows.
• Experience with Jira / Azure DevOps and Agile/Scrum.
• Strong client and stakeholder communication skills with the ability to drive discussions to decisions.

Preferred

• Payer/provider or utilization management experience.
• FHIR API / Postman experience.
• SQL or Python knowledge.