ePA Business Analyst

2 days ago

United States Impelsys Full-time
Role Summary
• Lead and support business analysis for Electronic Prior Authorization (ePA) delivery to meet CMS-0057 requirements for streamlined Prior Authorization (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/Utilization Management (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 experience in regulated software delivery, focused on ePA and interoperability.
• Strong understanding of Agile methodologies.
• Experience with requirement and project tracking tools (e.g., Jira, Azure DevOps).
• Ability to create clear documentation and workflow diagrams.
• Working knowledge of SQL and Python. Desired Attributes
• Strong analytical and problem-solving skills.
• Clear communication with technical and business teams.
• High attention to detail and organizational skills.
• Collaborative and proactive mindset. Key Activities 1. Requirements Definition
• Define and translate CMS-0057 ePA requirements, such as FHIR-based Prior Authorization API elements, mandated response timelines (≤72 hours for expedited requests and ≤7 days for standard requests), and structured denial reasons for payer systems. 2. PA Workflow & UM Integration
• Analyze current Prior Authorization processes with Utilization Management teams and UM vendors.
• Map existing workflow gaps and document requirements for automated ePA submissions, status updates, and decision workflows. 3. ePA Solution Translation & Planning
• Convert regulatory and operational requirements into user stories, acceptance criteria, and workflow diagrams.
• Guide the development of payer ePA APIs, internal systems, and provider interfaces. 4. Delivery & Implementation
• Collaborate with cross-functional teams to monitor ePA development.
• Manage UM vendor/API dependencies and validate deliverables against CMS timelines.
• Support payer compliance reporting.