Lead Business Analyst (Clinical Background)

Company Description

Lumen Solutions Group Inc. is a technology consulting Services company based in Florida. We provide a wide array of experienced business and IT professionals supporting clients from solution design to implementation and support. We specialize in professional IT consulting services, IT Staffing, Business/IT Strategy, Business Process Blueprints, Enterprise Architecture, Enterprise Transformation.

Role: Lead Business Analyst (Clinical Background)
Location: Reston VA - 100% Remote
Job Type: Contract

Job Summary:
We are seeking a Lead Business Analyst (Clinical) with strong healthcare domain expertise to drive business requirements, utilization management initiatives, and end-to-end business testing. This role will work closely with business, IT, and testing teams to ensure successful delivery of clinical and prior authorization solutions aligned with regulatory mandates.
Key Responsibilities:

• Lead business requirements gathering and documentation for clinical systems.
• Drive Utilization Management (UM) and Prior Authorization initiatives.
• Ensure end-to-end requirements traceability.
• Manage and support business testing and test remediation lifecycle.
• Collaborate with business, IT, and QA teams for project delivery.
• Lead RAID tracking, dependencies, and weekly project status reporting.
• Support provider onboarding and business readiness activities.
• Participate in large stakeholder meetings and drive discussions.
• Utilize tools like Jira for tracking and reporting.
• Work with PAS (Prior Authorization System) and integrated platforms.

Required Qualifications:

• Bachelor's degree or equivalent experience.
• 10+ years of experience as a Business Analyst in healthcare.
• Strong experience with Prior Authorization and Provider Data.
• Hands-on experience with Utilization Management (UM) and Clinical Operations.
• Clinical background with knowledge of CMS-0057F mandate.
• Experience with Medicare, Medicaid, and BCBSA plans.
• 2+ years of experience with GuidingCare or similar platforms (GIBA, Medecision).
• Strong experience in business testing and requirements traceability.
• Excellent communication and stakeholder management skills.
• Strong experience with Jira.

Preferred Skills:

• Experience with DTR/MCG platform integration.
• Knowledge of PAS (Prior Authorization System) workflows.
• Experience in project management and RAID tracking.
• Familiarity with SDLC, test strategies, and quality assurance processes.
• Experience with databases and query languages.
• Strong analytical and problem-solving skills.
• Experience in Agile environments.

Lumen Solutions Group Inc is an equal opportunity employer. All qualified applicants will be considered for employment without regard to any legally protected status.