Lead Business Systems Analyst – Interoperability & ePA ( electronic Prior Authorization) : Newark, NJ

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Deepika Dua

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Jun 30, 2026, 2:27:53 PM (15 hours ago) Jun 30
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Greetings,

Please check below Job Description :

 

Please share 12+ Years experience candidates 

Include contact details and the LinkedIn profile link of the candidate in the email.

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Please carefully read the Job Description below, and if you would like to pursue this opportunity, please email me an updated MS Word version of your resume to Deep...@VBeyond.com at your earliest convenience.  If you're not interested feel free to send me your resume and let me know what type of positions, I can help you with. I appreciate your time and look forward to hearing from you. 

 

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

Location : Newark, NJ

Duration : Long term Contract

 

Lead Business Systems Analyst – Interoperability & ePA ( electronic Prior Authorization)

Primary Responsibilities

Requirements Leadership

  • Own end-to-end business and functional requirements for ePA, CRD, DTR, and PAS.
  • Facilitate requirement sessions across business, operations, and technology teams.
  • Translate regulatory requirements into business and technical requirements.
  • Maintain requirements traceability from CMS regulations through implementation and testing.

Vendor Management

  • Act as primary day-to-day requirements lead with Availity.
  • Review vendor assumptions, solution designs, workflows, and implementation approaches.
  • Track gaps, risks, dependencies, and open decisions.

FHIR & Interoperability Analysis

  • Understand CRD, DTR, PAS, Patient Access, Provider Access, and Payer-to-Payer workflows.
  • Analyze FHIR resource requirements and data mapping needs.
  • Partner with API teams on business workflow impacts.
  • Cross-Team Coordination

Coordinate between:

  • UM
  • Medical Policy
  • Clinical Teams
  • Horizon API Team
  • Availity
  • Cognizant
  • Prime
  • Enterprise Architecture
  • Testing

Testing & Readiness

  • Define business test scenarios.
  • Coordinate end-to-end testing.
  • Validate provider workflows.
  • Support CMS and BCBSA compliance readiness.

Required Experience

Must Have

  • 8+ years as BSA/Product Owner/Product Manager
  • Healthcare payer experience
  • Prior Authorization experience
  • Vendor management experience
  • API integration experience
  • Strong facilitation and stakeholder management skills
  • Highly Preferred
  • FHIR
  • CMS-0057-F
  • CRD/DTR/PAS
  • HL7
  • Interoperability programs
  • Utilization Management workflows
  • Medical Policy systems

 

Regards,
Deepika Dua

VBeyond Corporation

Desk # +1-908 633 4076

https://www.linkedin.com/in/deepika-dua-018459166/

E: Deep...@vbeyond.com | www.vbeyond.com

390 Amwell Road, Suite # 107, Hillsborough, NJ 08844

 


Note – VBeyond is fully committed to Diversity and Equal Employment Opportunity.

 

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