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We are currently seeking a Sr. Business Analyst CMS Interoperability 0057 Rule to join our team in Baltimore, Maryland (US-MD), United States (US).

The Senior Business Analyst (BA) is responsible for helping decompose the CMS Interoperability Rule 0057 and identify the operational/business and technical requirements. Must work interactively with multiple MDH Operations Teams on how to implement the CMS Rule operational/business requirements once identified. Must develop strong trust and respect through collaboration with MDH Operation’s business stakeholders and technical project team members. 

The BA will:

•    Create a detailed Requirements Traceability Matrix (RTM) by decomposing and identifying the detailed Operations/Business and technical requirements in the CMS Interoperability Rule 0057 

•    Participate in team meetings with the MDH Operations/Business stakeholders to review the operations/business requirements

•    Collaborate with the MDH Operations/Business stakeholders to define how to implement the operations/business requirements as well as identify any data, workflow and processes changes

•    Ask thoughtful leading questions to help elicit the direction on how to implement the requirements. In addition to asking leading questions, the BA should listen to the business stakeholders to ensure that they understand what is being communicated

•    Work with the Technical Team to identify delivery options for operation/business requirements if needed

•    Demonstrate knowledge of Claims, clinical or Authorization data and payer processes around the business functions associated with claims adjudication, Authorization end-to-end workflow and/or clinical data for careplans

•    Review the detailed test scripts created by the QA Testing team to ensure thoroughly represent the technical requirements.

•    Support User Acceptance Testing (UAT)

Basic Qualifications

• Must have familiarity with the "CMS IO final rule" refers to the "CMS Interoperability and Prior Authorization Final Rule" (CMS-0057-F), which was released by the Centers for Medicare & Medicaid Services (CMS) on January 17, 2024.

• Bachelor’s Degree from an accredited college or university with a major in Computer Science, Information Systems, Engineering, Business, or other related scientific or technical discipline is required.

• 3 years related work experience as a Business Analyst in the payer healthcare domain; claims, authorization or clinical data in a payer healthcare arena.

• 3 years experience with business and technical requirements analysis, elicitation, modeling, etc in the healthcare domain specifically with Claims, Authorizations and/or Clinical Careplan functions, workflows and/or data

• 3 years experience with business and operations workflows, data and processes supporting Claims adjudication, Authorization lifecycle processes and or clinical/careplan functions.

• 3 years experience analyzing and verifying requirements for completeness, consistency, comprehensibility, feasibility, and conformity to organizational standards 

• 1 year experience with Agile delivery methodology