Healthcare Domain Technical Consultant

Job Title: Healthcare Domain Technical Consultant

Job Summary:

Healthcare Domain Technical Consultant

Key Responsibilities:

1. Healthcare Domain Consulting

• 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.

2. 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.

3. Regulatory Compliance & Security

HIPAA

• Advise on data privacy, security best practices, and role-based access controls.
• Participate in security audits, risk assessments, and compliance reporting.

4. 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.
• Present architecture and solution proposals to leadership, clients, and regulatory bodies.

5. 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 healthcare informatics, Computer Science, Information Systems, or related field.
• Master’s degree or healthcare certification preferred (e.g., CPHIMS, PMP, RHIA, HL7/FHIR Certification).
• Minimum 4–8 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.