InterOp BSA

Primary Responsibilities

• Leadership requirements ownership — Own end-to-end business and functional requirements for ePA, CRD, DTR, and Client.
• Requirements facilitation — Lead requirement discussions across business, operations, and technology teams.
• Regulatory translation — Convert regulatory mandates into clear business and technical requirements.
• Traceability management — Maintain full traceability from CMS regulations through implementation and testing.
• Vendor Management: Vendor requirements leadership — Serve as the primary day-to-day requirements lead with Availity.
• Vendor review — Evaluate vendor assumptions, solution designs, workflows, and implementation approaches.
• Risk and dependency tracking — Monitor gaps, risks, dependencies, and outstanding decisions.
• FHIR & Interoperability Analysis: Workflow understanding — Understand CRD, DTR, Client, Patient Access, Provider Access, and Payer-to-Payer workflows.
• FHIR analysis — Assess FHIR resource needs and data mapping requirements.
• API collaboration — Work with API teams to evaluate business workflow impacts.
• Cross-Team Coordination: Cross-functional coordination — Coordinate across UM, Medical Policy, Clinical Teams, API teams, Availity, Cognizant, Prime, Enterprise Architecture, and Testing.
• Testing & Readiness: Test scenario definition — Develop business test scenarios.
• Testing coordination — Oversee end-to-end testing activities.
• Workflow validation — Validate provider workflows.
• Compliance readiness — Support CMS and BCBSA compliance readiness efforts.

Required Experience

• Must Have: 8+ years as BSA, Product Owner, or 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-FCRD/DTR/Client; HL7; Interoperability programs; Utilization Management workflows; Medical Policy systems.