Senior Level Authorization Specialist Jobs
Senior level authorization specialist jobs place experienced professionals in charge of compliance frameworks, cross-functional approval workflows, and the teams responsible for executing them. Openings are concentrated across Insurance, Consulting & Professional Services, and Aerospace & Defense, with a 50% remote or hybrid share, and employers like Oscar Health, KBR, and McKesson hiring at this level now.
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Position Name: Lead Business Systems Analyst – Interoperability & Electronic Prior Authorization (ePA)
Location: Newark, NJ
Client: Leading U.S. Healthcare Enterprise
Work Schedule: 3 days/week from office
Description
We are seeking an experienced Lead Business Systems Analyst (BSA) to drive business analysis, requirements management, and stakeholder coordination for healthcare interoperability and Electronic Prior Authorization (ePA) initiatives. This role will serve as the primary liaison between business, technology, vendor, and operational teams to ensure successful implementation of CMS interoperability mandates and prior authorization workflows, including CRD (Coverage Requirements Discovery), DTR (Documentation Templates and Rules), PAS (Prior Authorization Support), Patient Access, Provider Access, and Payer-to-Payer solutions.
The ideal candidate will possess deep healthcare payer experience, strong business analysis expertise, vendor management skills, and a solid understanding of API integrations and interoperability frameworks.
Role and Responsibilities
Requirements Leadership:
- Own and manage end-to-end business and functional requirements for interoperability and ePA initiatives, including CRD, DTR, and PAS implementations.
- Lead requirements gathering sessions with business, operations, clinical, and technology stakeholders.
- Translate regulatory mandates, business needs, and operational processes into detailed business and technical requirements.
- Maintain complete requirements traceability from CMS regulations through design, development, testing, and implementation.
- Create and manage business process flows, use cases, user stories, and functional specifications.
Vendor Management
- Serve as the primary day-to-day requirements lead and liaison with external vendors, including Availity and other implementation partners.
- Review and validate vendor assumptions, solution designs, workflows, and implementation approaches.
- Identify and track project gaps, risks, dependencies, issues, and key decisions.
- Ensure vendor deliverables align with business objectives, compliance requirements, and implementation timelines.
FHIR & Interoperability Analysis
- Analyze and support interoperability workflows related to:
- Coverage Requirements Discovery (CRD)
- Documentation Templates and Rules (DTR)
- Prior Authorization Support (PAS)
- Patient Access APIs
- Provider Access APIs
- Payer-to-Payer Data Exchange
- Understand FHIR-based data exchange requirements and associated resource mappings.
- Collaborate with API and integration teams to assess business process impacts and implementation requirements.
- Support interoperability solution design discussions and requirements validation.
Cross-Functional Coordination
Coordinate and collaborate across multiple business and technology teams, including:
- Utilization Management (UM)
- Medical Policy
- Clinical Operations Teams
- API Development Teams
- Vendor Partners (Availity, Cognizant, Prime, etc.)
- Enterprise Architecture
- Quality Assurance and Testing Teams
- Program and Project Management stakeholders
Testing & Implementation Readiness
- Define business test scenarios, acceptance criteria, and validation requirements.
- Coordinate end-to-end testing activities across multiple systems and teams.
- Validate provider and member workflows to ensure business readiness.
- Support CMS interoperability compliance and regulatory readiness efforts.
- Participate in User Acceptance Testing (UAT) and implementation planning activities.
Core Skills & Qualifications
Must-Have Experience
- 8+ years of experience as a:
- Business Systems Analyst (BSA), or
- Product Owner, or
- Product Manager
- Strong healthcare payer industry experience.
- Hands-on experience with Prior Authorization processes and workflows.
- Experience managing and coordinating third-party vendors and implementation partners.
- Experience with API integrations and system integration projects.
- Excellent requirements elicitation, facilitation, and stakeholder management skills.
- Strong analytical, problem-solving, and communication abilities.
Highly Preferred Qualifications
- Experience with FHIR (Fast Healthcare Interoperability Resources).
- Knowledge of CMS-0057-F interoperability regulations.
- Experience implementing or supporting CRD, DTR, and PAS workflows.
- Knowledge of HL7 standards.
- Experience with healthcare interoperability programs and initiatives.
- Understanding of Utilization Management (UM) workflows.
- Familiarity with Medical Policy systems and processes.
- Experience working with healthcare APIs and digital healthcare ecosystems.
Preferred Qualifications
- Regulatory compliance analysis and requirements management.
- Healthcare interoperability and data exchange standards.
- Business process modeling and workflow analysis.
- Agile/Scrum delivery methodologies.
- Cross-functional leadership and stakeholder engagement.
- Risk, issue, and dependency management.
- End-to-end testing coordination and business validation.
Education
· Bachelor’s degree in Business, Healthcare Administration, Information Systems, Computer Science, or a related field.
· Relevant healthcare, business analysis, or interoperability certifications are a plus.
Pay: $55.00 - $75.00 per hour
Benefits:
- 401(k)
Work Location: Hybrid remote in Newark, NY 14513
Position Name: Lead Business Systems Analyst – Interoperability & Electronic Prior Authorization (ePA)
Location: Newark, NJ
Client: Leading U.S. Healthcare Enterprise
Work Schedule: 3 days/week from office
Description
We are seeking an experienced Lead Business Systems Analyst (BSA) to drive business analysis, requirements management, and stakeholder coordination for healthcare interoperability and Electronic Prior Authorization (ePA) initiatives. This role will serve as the primary liaison between business, technology, vendor, and operational teams to ensure successful implementation of CMS interoperability mandates and prior authorization workflows, including CRD (Coverage Requirements Discovery), DTR (Documentation Templates and Rules), PAS (Prior Authorization Support), Patient Access, Provider Access, and Payer-to-Payer solutions.
The ideal candidate will possess deep healthcare payer experience, strong business analysis expertise, vendor management skills, and a solid understanding of API integrations and interoperability frameworks.
Role and Responsibilities
Requirements Leadership:
- Own and manage end-to-end business and functional requirements for interoperability and ePA initiatives, including CRD, DTR, and PAS implementations.
- Lead requirements gathering sessions with business, operations, clinical, and technology stakeholders.
- Translate regulatory mandates, business needs, and operational processes into detailed business and technical requirements.
- Maintain complete requirements traceability from CMS regulations through design, development, testing, and implementation.
- Create and manage business process flows, use cases, user stories, and functional specifications.
Vendor Management
- Serve as the primary day-to-day requirements lead and liaison with external vendors, including Availity and other implementation partners.
- Review and validate vendor assumptions, solution designs, workflows, and implementation approaches.
- Identify and track project gaps, risks, dependencies, issues, and key decisions.
- Ensure vendor deliverables align with business objectives, compliance requirements, and implementation timelines.
FHIR & Interoperability Analysis
- Analyze and support interoperability workflows related to:
- Coverage Requirements Discovery (CRD)
- Documentation Templates and Rules (DTR)
- Prior Authorization Support (PAS)
- Patient Access APIs
- Provider Access APIs
- Payer-to-Payer Data Exchange
- Understand FHIR-based data exchange requirements and associated resource mappings.
- Collaborate with API and integration teams to assess business process impacts and implementation requirements.
- Support interoperability solution design discussions and requirements validation.
Cross-Functional Coordination
Coordinate and collaborate across multiple business and technology teams, including:
- Utilization Management (UM)
- Medical Policy
- Clinical Operations Teams
- API Development Teams
- Vendor Partners (Availity, Cognizant, Prime, etc.)
- Enterprise Architecture
- Quality Assurance and Testing Teams
- Program and Project Management stakeholders
Testing & Implementation Readiness
- Define business test scenarios, acceptance criteria, and validation requirements.
- Coordinate end-to-end testing activities across multiple systems and teams.
- Validate provider and member workflows to ensure business readiness.
- Support CMS interoperability compliance and regulatory readiness efforts.
- Participate in User Acceptance Testing (UAT) and implementation planning activities.
Core Skills & Qualifications
Must-Have Experience
- 8+ years of experience as a:
- Business Systems Analyst (BSA), or
- Product Owner, or
- Product Manager
- Strong healthcare payer industry experience.
- Hands-on experience with Prior Authorization processes and workflows.
- Experience managing and coordinating third-party vendors and implementation partners.
- Experience with API integrations and system integration projects.
- Excellent requirements elicitation, facilitation, and stakeholder management skills.
- Strong analytical, problem-solving, and communication abilities.
Highly Preferred Qualifications
- Experience with FHIR (Fast Healthcare Interoperability Resources).
- Knowledge of CMS-0057-F interoperability regulations.
- Experience implementing or supporting CRD, DTR, and PAS workflows.
- Knowledge of HL7 standards.
- Experience with healthcare interoperability programs and initiatives.
- Understanding of Utilization Management (UM) workflows.
- Familiarity with Medical Policy systems and processes.
- Experience working with healthcare APIs and digital healthcare ecosystems.
Preferred Qualifications
- Regulatory compliance analysis and requirements management.
- Healthcare interoperability and data exchange standards.
- Business process modeling and workflow analysis.
- Agile/Scrum delivery methodologies.
- Cross-functional leadership and stakeholder engagement.
- Risk, issue, and dependency management.
- End-to-end testing coordination and business validation.
Education
· Bachelor’s degree in Business, Healthcare Administration, Information Systems, Computer Science, or a related field.
· Relevant healthcare, business analysis, or interoperability certifications are a plus.
Pay: $55.00 - $75.00 per hour
Benefits:
- 401(k)
Work Location: Hybrid remote in Newark, NY 14513
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Top Industries Hiring
- Insurance
- Consulting & Professional Services
- Aerospace & Defense
- Technology & Software
Senior Level Authorization Specialist Jobs: Frequently Asked Questions
How do I get a senior level authorization specialist job?
Employers hiring at this level look for candidates who have owned end-to-end authorization processes, not just participated in them. Demonstrate that you have designed or overhauled a compliance or approval workflow, resolved high-stakes exceptions independently, and mentored junior staff through complex cases. A portfolio of process improvements or audit outcomes makes a stronger case than tenure alone.
Which companies hire senior level authorization specialists?
Companies hiring senior level authorization specialists right now include Oscar Health, KBR, and McKesson, based on current listings on Migrate Mate as of July 2026. At this level, hiring tends to come from organizations with regulated operations, large-scale approval pipelines, or compliance functions that require experienced oversight rather than entry-level execution.
Are there remote senior level authorization specialist jobs?
Yes, though availability varies by employer and industry. About 50% of senior level authorization specialist openings are remote or hybrid as of July 2026, reflecting demand from organizations comfortable delegating compliance leadership to experienced professionals working outside a central office. On-site roles remain common where secure systems or regulatory presence is required.
What makes an authorization specialist role senior level?
Senior level roles are defined by ownership rather than execution. Where mid-level specialists process and review, senior specialists design the frameworks, set escalation standards, and are accountable for compliance outcomes across a department or product line. They typically mentor junior and mid-level colleagues, interface directly with legal or regulatory stakeholders, and drive policy decisions rather than follow them.
Which industries hire the most senior level authorization specialists?
Senior level authorization specialist roles concentrate in Insurance, Consulting & Professional Services, and Aerospace & Defense, based on current listings on Migrate Mate as of July 2026. These sectors drive hiring at this level because their authorization workflows carry significant regulatory, financial, or operational risk that requires experienced professionals to manage rather than generalists to support.