Senior Business System Analyst

CGI•Canton, MA

8d•Hybrid

About The Position

The Business Systems Analyst (BSA) will play a key role in driving interoperability initiatives for healthcare payer organizations. This role focuses on implementing solutions aligned with CMS and ONC interoperability mandates, enhancing data exchange capabilities, and supporting end-to-end solution design across clinical, administrative, and member-facing systems. The BSA will collaborate with cross-functional teams—including product owners, architects, developers, QA, and business stakeholders—to ensure compliant, scalable, and efficient interoperability implementations. This position is based in our Canton, MA client office - Hybrid 2 days a week

Requirements

8-10 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.

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.