Senior Healthcare Domain Specialist

Healthcare Technical Expert

We are seeking a skilled and knowledgeable technical professional with in-depth exposure to the U.S. healthcare market.

The ideal candidate will work closely with clients and internal teams to design, implement, and support technology solutions that align with healthcare operational needs, regulatory compliance, and digital transformation strategies.

This position requires a deep understanding of healthcare processes, standards (e.g., HIPAA, HL7, FHIR), payer and provider systems, and health IT platforms.

Key Responsibilities:

• Analyze and document business processes across U.S. healthcare organizations (e.g., payers, providers, PBMs, clearinghouses).
• Provide subject matter expertise on U.S. healthcare regulations, insurance models (Medicare, Medicaid, commercial), claims lifecycle, EHR/EMR systems, and care coordination workflows.
• Identify improvement opportunities for clinical, administrative, and operational systems through technology.

Technical Solution Delivery:

• Collaborate with engineering and business teams to design and implement healthcare IT solutions.
• Translate complex business and compliance requirements into functional and technical specifications.
• Support the configuration, customization, and integration of EHR systems (e.g., Epic, Cerner), payer platforms, or health information exchanges (HIEs).
• Lead data mapping and transformation efforts for claims (EDI X12 837, 835), enrolment (834), eligibility (270/271), and HL7/FHIR-based interfaces.

Regulatory Compliance & Security:

• Ensure solutions comply with U.S. healthcare regulations such as HIPAA, HITECH, CMS mandates, and NCQA standards.
• Advise on data privacy, security best practices, and role-based access controls.
• Participate in security audits, risk assessments, and compliance reporting.

Stakeholder Engagement & Communication:

• Serve as the liaison between business users (e.g., clinicians, billing teams) and technical staff (developers, system integrators).
• Conduct stakeholder workshops, gap analysis, and user training.
• Presentation of architecture and solution proposals to leadership, clients, and regulatory bodies.

Testing & Support:

• Design and execute test cases for functional, integration, and compliance testing.
• Support UAT, go-live, and post-deployment activities, including troubleshooting and change management.
• Document workflows, integration points, and business logic for ongoing support.

Required Skills and Experience:

• Domain Expertise:
  • Deep understanding of U.S. healthcare payer/provider workflows.
  • Knowledge of claims processing, revenue cycle management (RCM), utilization management, and clinical decision support.
  • Familiarity with care models (ACO, PCMH), population health, and value-based care metrics.
• Technical Skills:
  • Proficiency in health data exchange standards: HL7 v2.x, CDA, FHIR, X12 EDI (especially 837/835/270/271).
  • Experience with EHR/EMR systems: Epic, Cerner, Allscripts, Meditech, or similar.
  • Integration experience using APIs, middleware (e.g., Mirth Connect, Cloverleaf), and data warehouses.
  • Strong data analysis and transformation skills using SQL, XML/JSON, or Python preferred.
  • Experience with analytics/reporting tools (Power BI, Tableau) a plus.
• Project & Methodology:
  • Experience working in Agile or Scrum environments.
  • Familiarity with business analysis tools (JIRA, Confluence, Visio, etc.).
  • Strong documentation, requirement-gathering, and use-case creation skills.
• Education and Certifications:
  • Bachelor's degree in Computer Science, Information Systems, or related field.
  • Minimum 4 to 8 years of relevant experience in healthcare IT consulting or domain-focused technical roles.
• Soft Skills:
  • Strong verbal and written communication skills, particularly in cross-functional and regulated environments.
  • Ability to distill complex information for both technical and non-technical audiences.
  • Problem-solving mindset with strong attention to detail and regulatory implications.
  • Adaptability in fast-paced environments with evolving requirements.

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