Healthcare Interoperability & Compliance SME (X12 278 / FHIR / CMS-57F)
Must Have FHIR EDI 278, CMS 57 Experience
Healthcare Interoperability & Compliance SME (X12 278 / FHIR / CMS-57F)
Role Summary
We are seeking a Healthcare Interoperability Subject Matter Expert (SME) with strong hands-on experience in X12 278 transactions, HL7 FHIR standards, and CMS-57F compliance. The SME will support regulatory compliance, guide implementation teams, and ensure healthcare data exchange solutions align with CMS and industry standards.
Key Responsibilities
ā¢ Serve as SME for X12 278 (Prior Authorization) workflows, including inbound/outbound transactions, acknowledgments, and error handling.
ā¢ Provide expert guidance on HL7 FHIR standards, including FHIR resources, APIs, profiles, and implementation guides relevant to CMS regulations.
ā¢ Ensure solution compliance with CMS-57F mandates, including Prior Authorization requirements and interoperability timelines.
ā¢ Interpret CMS regulations and translate them into technical and functional requirements for delivery teams.
ā¢ Support design reviews, architecture discussions, and solution validation to ensure regulatory adherence.
ā¢ Collaborate with product owners, architects, developers, QA, and client stakeholders.
ā¢ Review mapping documents, data models, and integration flows for compliance and accuracy.
ā¢ Assist with client discussions, audits, and regulatory readiness assessments.
ā¢ Provide guidance on best practices for healthcare interoperability, security, and data governance.
ā¢ Support documentation, compliance artifacts, and knowledge transfer activities.
Required Skills & Experience
ā¢ 8+ years of experience in healthcare IT with strong domain expertise.
ā¢ Deep hands-on knowledge of X12 EDI, specifically 278 Prior Authorization transactions.
ā¢ Strong experience with HL7 FHIR (R4 preferred), FHIR APIs, and implementation guides.
ā¢ Proven experience supporting CMS-57F compliance and CMS interoperability mandates.
ā¢ Understanding of payer-provider workflows, utilization management, and prior authorization processes.
ā¢ Experience working with EHR/EMR systems, clearinghouses, and payer platforms.
ā¢ Ability to translate regulatory requirements into technical and functional solutions.
ā¢ Excellent communication skills to work with both technical and non-technical stakeholders.
Preferred Qualifications
ā¢ Experience with CMS Interoperability and Prior Authorization Final Rule implementations.
ā¢ Familiarity with OAuth 2.0, SMART on FHIR, and healthcare security standards.
ā¢ Exposure to cloud-based healthcare platforms (Azure, AWS, GCP).
ā¢ Experience supporting large payer or healthcare transformation programs.
ā¢ Prior experience in client-facing SME or consulting roles.
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Healthcare Interoperability & Compliance SME (X12 278 / FHIR / CMS-57F)
Role Summary
We are seeking a Healthcare Interoperability Subject Matter Expert (SME) with strong hands-on experience in X12 278 transactions, HL7 FHIR standards, and CMS-57F compliance. The SME will support regulatory compliance, guide implementation teams, and ensure healthcare data exchange solutions align with CMS and industry standards.
Key Responsibilities
ā¢ Serve as SME for X12 278 (Prior Authorization) workflows, including inbound/outbound transactions, acknowledgments, and error handling.
ā¢ Provide expert guidance on HL7 FHIR standards, including FHIR resources, APIs, profiles, and implementation guides relevant to CMS regulations.
ā¢ Ensure solution compliance with CMS-57F mandates, including Prior Authorization requirements and interoperability timelines.
ā¢ Interpret CMS regulations and translate them into technical and functional requirements for delivery teams.
ā¢ Support design reviews, architecture discussions, and solution validation to ensure regulatory adherence.
ā¢ Collaborate with product owners, architects, developers, QA, and client stakeholders.
ā¢ Review mapping documents, data models, and integration flows for compliance and accuracy.
ā¢ Assist with client discussions, audits, and regulatory readiness assessments.
ā¢ Provide guidance on best practices for healthcare interoperability, security, and data governance.
ā¢ Support documentation, compliance artifacts, and knowledge transfer activities.
Required Skills & Experience
ā¢ 8+ years of experience in healthcare IT with strong domain expertise.
ā¢ Deep hands-on knowledge of X12 EDI, specifically 278 Prior Authorization transactions.
ā¢ Strong experience with HL7 FHIR (R4 preferred), FHIR APIs, and implementation guides.
ā¢ Proven experience supporting CMS-57F compliance and CMS interoperability mandates.
ā¢ Understanding of payer-provider workflows, utilization management, and prior authorization processes.
ā¢ Experience working with EHR/EMR systems, clearinghouses, and payer platforms.
ā¢ Ability to translate regulatory requirements into technical and functional solutions.
ā¢ Excellent communication skills to work with both technical and non-technical stakeholders.
Preferred Qualifications
ā¢ Experience with CMS Interoperability and Prior Authorization Final Rule implementations.
ā¢ Familiarity with OAuth 2.0, SMART on FHIR, and healthcare security standards.
ā¢ Exposure to cloud-based healthcare platforms (Azure, AWS, GCP).
ā¢ Experience supporting large payer or healthcare transformation programs.
ā¢ Prior experience in client-facing SME or consulting roles.
Apply tot his job
Apply To this Job