Key responsibilities

Regulatory analysis and interpretation: Analyze and interpret the CMS-0057-F rule and related FHIR Implementation Guides (IGs), such as CARIN BB, US Core, Da Vinci PDEX, and Da Vinci CRD, DTR, and PAS, to translate complex regulatory requirements into detailed technical specifications.

Requirements gathering: Collaborate with product managers, product owners, operational, and technical stakeholders to define the business and data requirements for implementing new FHIR-based APIs and updating existing ones.

Data mapping and modeling: Perform in-depth data analysis and mapping exercises, linking proprietary source system data to the appropriate FHIR resources and profiles, as well as integration with Electronic Health Records (EHRs), such as Epic and Cerner, using FHIR APIs.

FHIR API implementation support: Assist development teams in the design, development, and testing of the following FHIR-based APIs mandated by CMS-0057-F:

oPrior Authorization API: Enable the electronic exchange of prior authorization requests and responses between payers and providers.

oPatient Access API: Maintain and enhance the FHIR Patient Access API to meet new reporting metrics and data requirements.

oProvider Access API: Facilitate the secure exchange of patient data with in-network providers.

oPayer-to-Payer API: Support the exchange of patient claims, clinical, and prior authorization data when a patient switches health plans.

Testing and validation: Create functional test cases, execute testing using tools like Postman, and validate FHIR outputs against implementation guides to ensure compliance and data quality.

Documentation and reporting: Develop comprehensive documentation, including data flow diagrams, FHIR API specifications, and test results.



Assist in generating the CMS Interoperability Patient Access API and prior authorization metrics required for public reporting to CMS.

Issue resolution: Perform root cause analysis and collaborate with technical teams and operations to resolve data quality and integration issues.

Qualifications

Education: Bachelor's degree in a relevant field, such as Health Informatics, Computer Science, or Business.

Experience: 3+ years of experience as a data or systems analyst in the US healthcare industry, with a focus on HL7 FHIR and interoperability projects and a robust understanding of clinical codes and EHR integrations using HL7 FHIR APIs.

Regulatory knowledge: Strong understanding of CMS Interoperability and Prior Authorization regulations, including CMS-0057-F and its impact on payers and providers.

Technical skills:

oHands-on experience with FHIR API interactions, resources (e.g., Patient, Coverage, ServiceRequest), and Implementation Guides.

oProficiency in data analysis and mapping techniques working with source-to-target data mapping in a clinical setting.

oExperience with testing tools like Postman for API validation.

oIntermediate level experience with SQL for data profiling and analysis.

Privacy and Security Standards: Knowledge of data privacy and security regulations, such as HIPAA, to handle sensitive patient information during data exchange.

Interoperability standards: Subject matter expert with related healthcare standards such as HL7 v2, CCDA, USCDI, and clinical terminology like SNOMED, LOINC, CPT, etc.

Communication: Excellent communication skills, with the ability to bridge the gap between technical teams and business stakeholders.

Soft skills: Strong analytical, problem-solving, and collaboration skills, with meticulous attention to detail.

Stakeholder engagement: Provide technical guidance and education on HL7 FHIR standards to business and technology teams to drive adoption and alignment with CMS requirements.

📌 Data Analyst (Pune)
🏢 Persistent
📍 Pune