Job Title

About the CompanyThreatXIntel is a fast-growing Cybersecurity, IT Staffing, and Consulting company delivering end-to-end technology and security solutions. Our expertise spans cloud security, web & mobile application security testing, DevSecOps, vulnerability assessments, IT consulting, and professional staffing services.We support global corporate clients by deploying skilled professionals across IT and finance domains, helping organizations strengthen compliance, optimize operations, and scale efficiently.Role OverviewWe are looking for a Lead Technical Business Analyst with strong expertise in Healthcare Interoperability, CMS regulations, and FHIR-based APIs.This role requires a professional who can effectively bridge regulatory requirements and technical implementation, ensuring compliance while driving scalable solutions.Key ResponsibilitiesAnalyze CMS-0057-F regulations and related CMS guidanceIdentify payer obligations, compliance requirements, and timelinesTranslate regulatory requirements into:Business requirementsFunctional specificationsAcceptance criteriaMap CMS requirements to:FHIR API capabilitiesUtilization Management (UM) workflowsAtrezzo system functionalitiesMaintain Regulatory Traceability Matrix (RTM)Define and document requirements for:FHIR R4 resources (Coverage, Claim, Claim Response, Prior Authorization, Questionnaire, Document Reference)Patient, Provider & Payer-to-Payer APIsFHIR-based Prior Authorization workflowsCollaborate with architects and developers on industry standards (CARIN, Da Vinci implementation guides)Convert business needs into:API-level user storiesData mappingsWorkflow diagramsAct as SME for Utilization Management (UM)Document current and future state workflowsIdentify system gaps vs CMS requirementsDefine configuration vs customization in ANG/Atrezzo systemsMandatory SkillsLead-level Business Analysis experienceStrong knowledge of CMS RegulationsExperience in EDI Transactions & Healthcare InteroperabilityExpertise in HL7 & FHIR (R4)Good to HaveStrong stakeholder management skillsExcellent requirements documentation & communicationIdeal CandidateExperience working with US Healthcare systemsHands-on exposure to FHIR APIs and Prior Authorization workflowsAbility to work in a cross-functional, fast-paced environment