Senior Business Analyst – Healthcare Interoperability

📋 Description

• Evaluate business requirements associated with healthcare data exchange and interoperability processes.

• Examine substantial volumes of raw healthcare data from various source systems, including flat files, databases, and formats (claims, member, provider, clinical, enrollment, financial) to determine structure, relationships, and consistency.

• Investigate connections between data types (e.g., linking members to claims, providers to encounters) to guarantee data accuracy and completeness.

• Facilitate discovery and integration workshops with stakeholders from providers and payers to establish interface specifications and data mappings.

• Create functional and technical requirements for both inbound and outbound interfaces, including healthcare data (HL7, FHIR, CDA, CCD, X12, etc.) specifications for development and integration teams.

• Analyze and document data integrity issues, undesirable data patterns, missing values, and duplicates.

• Standardize and transform healthcare data into recognized formats (HL7 v2, HL7 FHIR, X12 EDI, CCD/C-CDA, proprietary formats).

• Collaborate with both internal and external stakeholders to collect data requirements and outline technical specifications.

• Partner with stakeholders to grasp business objectives, integration needs, and compliance requirements.

• Work alongside integration teams to devise efficient, automated processes for data exchange among payer, provider, and third-party systems.

• Ensure that solutions adhere to HIPAA, CMS interoperability regulations, ONC guidelines, and other compliance mandates.

• Collaborate with product managers, architects, and developers to confirm that interoperability solutions fulfill business necessities.

• Design and implement test cases for data transformations and integrations.

• Verify that data outputs conform to both business rules and technical specifications.

• Ensure data accuracy and integrity across systems utilizing SQL and data profiling tools.

• Aid in root cause analysis and resolution of integration or data quality challenges.

• Support UAT (User Acceptance Testing) for interoperability solutions and coordinate with QA teams on test preparation and validation.

• Stay informed on industry standards and regulations regarding health data exchange and contribute to strategy and compliance initiatives.

• Assist the development team with performance analysis and testing during release cycles for service packs, hot fixes, etc.

• Provide a consistent, responsive, and satisfying customer experience with every project.

• Mentor junior BAs and conduct peer reviews of BRDs, user stories, and test plans.

⛳️ Requirements

• Bachelor's degree in health informatics, Computer Science, Data Science, Public Health, Information Systems, or a related field.

• Over 5 years of experience as a Business/Data Analyst in the healthcare sector, focusing on interoperability or health data engineering.

• In-depth knowledge of healthcare interoperability standards (HL7 v2, HL7 FHIR, X12 EDI, NCPDP, C-CDA).

• Comprehensive understanding of FHIR R4 structure, resource types, profiles, and terminology (LOINC, SNOMED, ICD).

• Experience with data ingestion and ETL pipelines in healthcare settings.

• Proficient in writing SQL queries for data validation and profiling.

• Familiarity with various data formats: JSON, XML, HL7v2 messages, X12, flat files (CSV, pipe-delimited, etc.).

• Experience using integration engines or tools (e.g., Mirth Connect, InterSystems, AWS Glue, Talend) is advantageous.

• Knowledge of API-based data exchange (FHIR RESTful APIs) and SMART on FHIR concepts.

• Experience with HIE systems and clinical data repositories.

• Proven ability to analyze large datasets (millions of rows) and complex multi-file healthcare data structures.

• Expertise in healthcare data domains: member, claims, provider, enrollment, and clinical data.

🏝️ Benefits

• Medical, dental, vision, disability, and life insurance coverage.

• 401(k) savings plans.

• Paid family leave.

• 9 paid holidays each year.

• 17-27 days of Paid Time Off (PTO) annually.