Business System Analyst – Interoperability

CGI•Canton, MA

1d•Hybrid

About The Position

The Interoperability Business Systems Analyst is a strategic and hands-on implementation partner within a healthcare payer organization, responsible for driving the end-to-end evaluation, onboarding, and operational integration of digital health vendor solutions. This role owns the business and technical requirements lifecycle for a growing portfolio of point solutions across musculoskeletal health, behavioral health, chronic disease management, remote patient monitoring, and wellness — spanning vendors such as Hinge Health, Omada, Livongo, Sword Health, Calm, Teladoc, Brightline, and others. The BSA bridges strategy and execution: translating clinical program goals and payer operations requirements into technical specifications, data exchange designs, and vendor accountability frameworks. This individual will work closely with clinical, network, IT, product, compliance, and vendor teams to ensure that each digital health solution is implemented on time, within scope, and delivers measurable member and business outcomes.

Requirements

7-10 years of experience as a Business Analyst or Business Systems Analyst in the healthcare payer domain.
Strong understanding of FHIR standards, HL7, EDI transactions, and healthcare information exchange models.
Hands-on experience with interoperability implementations, preferably CMS-mandated FHIR APIs or payer modernization initiatives.
Working knowledge of healthcare payer systems and processes (benefits, claims, enrollment, provider data, UM/PA).
Experience writing business, functional and technical specs, data mapping documents, and business process flows.
Strong analytical, problem-solving, and communication skills.
Oracle SQL

Nice To Haves

Business Analysis
Functional Analysis
Health Care Analytics
Health Care Payers

Responsibilities

Gather, document, and validate business and technical requirements for interoperability solutions such as FHIR APIs, Member Access APIs, Provider Directory APIs, Payer-to-Payer Data Exchange, and Prior Authorization APIs.
Analyze CMS/ONC regulations (e.g., CMS Interoperability & Patient Access Rule, CMS Prior Authorization Rule, TEFCA-related requirements) and translate them into actionable system requirements.
Support gap analysis for existing payer systems (claims, clinical data, provider, member, authorization) to determine interoperability readiness.
Develop functional specifications, user stories, acceptance criteria, and process workflows for interoperability implementations.
Work with architects and engineers to define data mapping, transformation logic, and API interaction models aligned with HL7 FHIR standards.
Ensure solutions integrate effectively with enterprise systems such as claims adjudication, enrollment, provider management, UM/PA, care management, and data warehouses.
Perform data profiling and mapping for clinical and administrative datasets (e.g., EDI 837/835, 270/271, CCDA, FHIR resources).
Support test case development, test planning, and execution for API validation, edge-case handling, and compliance testing.
Ensure data accuracy, completeness, and compliance with security and privacy standards (HIPAA, PHI/PII handling).
Serve as the liaison between business stakeholders and technical teams, ensuring alignment on requirements, scope, and delivery timelines.
Participate in sprint planning, backlog grooming, and solution demonstrations as part of Agile/Scrum teams.
Provide subject matter expertise (SME) on payer workflows such as claims processing, member onboarding, provider data management, care management, and prior authorizations.