11 days ago
Healthcare Interoperability & Compliance SME
Jobs via Dice
Hybrid
Full Time
$175,000
Hybrid
Job Overview
Job TitleHealthcare Interoperability & Compliance SME
Job TypeFull Time
CategoryCommerce
Experience5 Years
DegreeMaster
Offered Salary$175,000
LocationHybrid
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Job Description
Introduction
We are seeking a Healthcare Interoperability Subject Matter Expert (SME) to support regulatory compliance and guide implementation teams in healthcare data exchange solutions. The Healthcare Interoperability & Compliance SME will be crucial in ensuring our solutions meet the latest industry standards and regulatory requirements.
Responsibilities
- Serve as SME for X12 278 Prior Authorization workflows (inbound/outbound transactions, acknowledgments, error handling).
- Provide expert guidance on HL7 FHIR standards and CMS regulations.
- Ensure compliance with CMS-57F mandates, including prior authorization requirements and interoperability timelines.
- Translate CMS regulations into actionable technical and functional requirements.
- Participate in design reviews, architecture discussions, and audits.
- Review mapping documents, data models, and integration flows for compliance and accuracy.
- Collaborate with product owners, architects, developers, QA, and client stakeholders.
- Provide guidance on best practices for interoperability, security, and data governance.
- Support documentation, compliance artifacts, and knowledge transfer activities.
Requirements
- Deep hands-on knowledge of X12 EDI 278 Prior Authorization transactions.
- Strong experience with HL7 FHIR (R4 preferred), APIs, and implementation guides.
- Proven expertise in CMS-57F compliance and interoperability mandates.
- Understanding of payer-provider workflows, utilization management, and prior authorization processes.
- Experience with EHR/EMR systems, clearinghouses, and payer platforms.
- Ability to translate CMS regulations into technical and functional requirements.
- Excellent communication skills for technical and non-technical stakeholders.
Key skills/competency
- Healthcare Interoperability
- Regulatory Compliance
- X12 EDI 278
- HL7 FHIR (R4)
- CMS-57F Mandates
- Prior Authorization
- Payer-Provider Workflows
- Data Governance
- EHR/EMR Systems
- API Integration
How to Get Hired at Jobs via Dice
- Research Sirian Group Inc's culture: Study their mission, values, recent news, and employee testimonials on LinkedIn and Glassdoor.
- Tailor your resume: Highlight specific experience with X12 EDI 278, HL7 FHIR, and CMS-57F compliance for the Healthcare Interoperability & Compliance SME role.
- Prepare for technical deep dives: Be ready to discuss specific scenarios involving healthcare data exchange, prior authorization workflows, and regulatory compliance.
- Showcase problem-solving skills: During interviews, provide concrete examples of how you've translated complex regulations into actionable technical solutions.
- Network effectively: Connect with current and former Sirian Group Inc employees on LinkedIn to gain insights and potentially an internal referral.
Frequently Asked Questions
Find answers to common questions about this job opportunity
01What specific compliance mandates will a Healthcare Interoperability & Compliance SME at Sirian Group Inc focus on?
02How important is X12 EDI 278 experience for this Healthcare Interoperability & Compliance SME position?
03What is Sirian Group Inc's approach to HL7 FHIR implementation for the Healthcare Interoperability & Compliance SME?
04What kind of collaboration can a Healthcare Interoperability & Compliance SME expect within Sirian Group Inc?
05How does Sirian Group Inc support documentation and knowledge transfer for a Healthcare Interoperability & Compliance SME?
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