Role Overview
Senior Enterprise Data Architect with interoperability, FHIR, and HIE experience responsible for designing enterprise data exchange architecture supporting CMS interoperability mandates and payer-provider integration workflows.
This role supports implementation of Patient Access, Provider Access, Payer-to-Payer Exchange, and Prior Authorization solutions while enabling scalable transformation pipelines across claims, enrollment, provider, and clinical datasets. Experience integrating with Athena and enterprise HIE ecosystems is preferred.
Core Responsibilities
Interoperability Requirements Engineering
Lead requirements definition for CMS-0057 aligned interoperability interfaces
Translate business objectives into:
FHIR resource specifications
element-level transformation mappings
Define transformation logic across claims, enrollment, provider, and clinical datasets
FHIR Resource and Payload Validation
Work directly with FHIR artifacts including:
Patient
Coverage
ExplanationOfBenefit
Practitioner
Inspect and validate JSON / NDJSON payload structures
Confirm compliance with implementation guides and interoperability profiles
Assess impacts associated with US Core and USCDI upgrades
Cross-Layer Data Verification
Perform SQL-driven validation across source systems, transformation pipelines, and API exposure layers
Identify mapping defects, structural inconsistencies, and upstream data gaps
Collaborate with Databricks and engineering teams supporting FHIR generation pipelines
Vendor Integration Governance
Coordinate with interoperability vendors to review mappings and interface logic
Troubleshoot API and transformation issues across integration layers
Evaluate vendor outputs independently and escalate discrepancies
Validate end-to-end interoperability workflows across partner systems
API Delivery Support and Testing Enablement
Develop structured requirements artifacts including:
BRDs
user stories
acceptance criteria
Support interoperability testing across:
payload verification
SIT
UAT
release readiness checkpoints
Interoperability Risk Monitoring
Manage risks related to:
payer data availability and quality
FHIR specification evolution
vendor dependencies
payload performance integrity
Compliance Traceability and Audit Alignment
Maintain lineage visibility from payer datasets through FHIR resources to API responses
Support CMS compliance evidence preparation
Validate adherence to interoperability implementation profiles
Enable HIE integration traceability across enterprise exchange workflows
Required Capabilities
Strong payer-side domain expertise across claims, enrollment, provider datasets
Hands-on working knowledge of FHIR resource modeling and validation
Advanced SQL querying supporting pipeline verification
Ability to analyze REST API payload structures and interoperability artifacts
Experience diagnosing ingestion, mapping, and API exposure layer issues
Experience coordinating across vendors, platform teams, and engineering stakeholders
Familiarity with enterprise HIE architectures and Athena integration environments
Experience supporting CMS interoperability regulatory programs
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