InterOp BSA

About the role

This is a contract-to-hire position. Onsite presence is required 2 consecutive days per month; flexibility may be available for exceptional candidates.

Responsibilities

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

Requirements

• 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-F CRD/DTR/Client.
  • HL7.
  • Interoperability programs.
  • Utilization Management workflows.
  • Medical Policy systems.