Business Analyst

Business Analyst (ePA)

Location: Frisco, TX

Duration: 12 months to begin with.

Role Summary:

Lead and support business analysis for electronic prior authorization (ePA) delivery to meet CMS 0057 requirements for streamlined PA workflows and interoperability.

Translate regulatory and business needs into clear requirements, user stories, and actionable plans.

Facilitate collaboration and communication between U.S. stakeholders, clinical/UM teams, and distributed development teams.

Key Responsibilities:

Gather, analyze, and document business and functional requirements for ePA workflows and FHIR based API obligations.

Translate requirements into user stories, acceptance criteria, and process flows.

Facilitate sprint planning, backlog refinement, and stakeholder communication.

Track delivery progress, identify risks (including UM vendor coordination), and recommend corrective actions. Support quality, process improvements, and operational alignment.

 Technical Skills & Tools:

Business analysis in regulated software delivery focused on ePA and interoperability.

Strong understanding of Agile methodologies.

Experience with requirement and project tracking tools (e.g., Jira, ADo).

Ability to create clear documentation and workflow diagrams. SQL, Python

Requirements Definition

·         Define and translate CMS-0057 ePA requirements such as FHIR-based Prior Authorization API elements, mandated response timelines (≤72 hrs expedited; ≤7 days standard), and structured denial reasons for payer systems.

PA Workflow & UM Integration

·         Analyze current PA processes with Utilization Management teams and UM vendors, map gaps, and document requirements for automated ePA submission, status updates, and decision workflows.

ePA Solution Translation & Planning

·         Convert regulatory and operational needs into user stories, acceptance criteria, and workflow diagrams that guide development of payer ePA APIs, internal systems, and provider interfaces.

Delivery & Implementation

·         Collaborate with cross-functional teams to monitor ePA development, manage UM vendor/API dependencies, validate deliverables against CMS timelines and support payer compliance reporting.