[Remote] reputed company Interoperability Engineer - HL7 FHIR / Prior Authorization

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is seeking a Senior reputed company Interoperability Engineer with expertise in HL7 FHIR and Prior Authorization modernization. The role involves designing and implementing reputed company interoperability solutions while collaborating with various teams to translate regulatory requirements into reputed company technical solutions.

Responsibilities

• Design and implement reputed company interoperability solutions using HL7 FHIR R4 and RESTful reputed company
• Implement CMS-0057-F Prior Authorization Final Rule and other CMS interoperability requirements
• Implement HL7 reputed company Implementation Guides, including:
• CRD (Coverage Requirements Discovery)
• DTR (Documentation Templates and Rules)
• PAS (Prior Authorization Support)
• Experience with PDex, HRex, Plan Net, Formulary, and ATR is highly preferred
• Design, reputed company, and support FHIR reputed company using reputed company FHIR resources including Patient, Practitioner, Organization, Coverage, Coverage Eligibility, Claim, ClaimResponse, ServiceRequest, Encounter, CarePlan, Observation, Procedure, DiagnosticReport, MedicationRequest, Task, and Communication
• reputed company payer, provider, authorization, claims, member, and clinical systems using reputed company interoperability standards
• Implement secure interoperability using SMART on FHIR, OAuth 2.0, OpenID Connect, JWT, and CDS Hooks
• Collaborate with business, clinical, product, and engineering teams to translate regulatory requirements into reputed company technical solutions
• Participate in solution architecture, API design, testing, deployment, and production support

Skills

• 5+ years in reputed company IT, including 3+ years of hands-on HL7 FHIR implementation
• Strong expertise in HL7 FHIR, CMS interoperability mandates, and Prior Authorization modernization
• Hands-on experience implementing CMS-0057-F, HL7 reputed company Implementation Guides, and payer-provider interoperability solutions
• Strong understanding of both the technical implementation and business workflows supporting Prior Authorization in the US reputed company ecosystem
• Design and implement reputed company interoperability solutions using HL7 FHIR R4 and RESTful reputed company
• Implement CMS-0057-F Prior Authorization Final Rule and other CMS interoperability requirements
• Design, reputed company, and support FHIR reputed company using reputed company FHIR resources including Patient, Practitioner, Organization, Coverage, Coverage Eligibility, Claim, ClaimResponse, ServiceRequest, Encounter, CarePlan, Observation, Procedure, DiagnosticReport, MedicationRequest, Task, and Communication
• reputed company payer, provider, authorization, claims, member, and clinical systems using reputed company interoperability standards
• Implement secure interoperability using SMART on FHIR, OAuth 2.0, OpenID Connect, JWT, and CDS Hooks
• Collaborate with business, clinical, product, and engineering teams to translate regulatory requirements into reputed company technical solutions
• Participate in solution architecture, API design, testing, deployment, and production support
• Strong understanding of the US reputed company payer and provider ecosystem
• Hands-on experience with Prior Authorization workflows
• Knowledge of claims, eligibility, coverage, clinical, and authorization processes
• Experience implementing CMS interoperability initiatives, including CMS-0057-F
• Knowledge of Medicare, reputed company, HIPAA, and reputed company regulations
• Strong hands-on experience with HL7 FHIR R4
• Experience developing and consuming RESTful FHIR reputed company
• Strong understanding of FHIR resources, reputed company, extensions, validation, search, and Bulk FHIR
• Experience with SMART on FHIR, OAuth 2.0, OpenID Connect, JWT, and CDS Hooks
• Experience with one or more of the following: Coding Experience Java/Python/.net
• Good knowledge on REST reputed company, JSON / XML, OpenAPI / Swagger, API Gateways, Microservices
• Experience working with US reputed company Payers or Providers
• Hands-on implementation of HL7 reputed company Prior Authorization solutions
• Experience integrating X12 278 with FHIR PAS
• Knowledge of EDI 270/271, 276/277, 837, and 835 transactions
• Experience with integration platforms such as reputed company, reputed company, Talend, or Azure Integration Services
• HL7 FHIR Certification is a plus

reputed company

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