Overview
On Site
Depends on Experience
Contract - W2
Job Details
Data Engineer (MRF & Interoperability Focus)
Location: Tulsa, OK (hybrid onsite)Schedule: M-F, 8-5 (CST)
Type: long-term contract
Remote: Available
Equipment: Provided
Rate: DOE
Position Summary
The Data Engineer is responsible for designing, building, and maintaining the data pipelines, data models, and data integration frameworks that support the Health Plan’s operational, regulatory, and analytics needs. This role plays a critical part in ensuring compliance with CMS and state regulations, including Transparency in Coverage (TiC) Machine Readable Files and Interoperability Final Rule (Patient Access, Provider Access, Payer-to-Payer, and Prior Authorization APIs).The ideal candidate has strong experience in healthcare data, particularly claims, eligibility, provider, and pricing data, as well as familiarity with FHIR standards and the creation of FHIR-ready data extracts. The Data Engineer will collaborate closely with IT, Informatics, Compliance, and vendor partners to ensure regulatory accuracy and timeliness.
Key Responsibilities
Data Engineering & Pipeline Development:- Design, build, and maintain scalable ETL/ELT pipelines for claims, enrollment, provider, pricing, clinical, and pharmacy datasets.
- Develop automated workflows to generate FHIR-ready extracts, including Patient, Member Attribution, Provider, Coverage, Encounter, EOB, and Prior Authorization data.
- Build and maintain processes to produce Machine Readable Files (MRFs) for Transparency in Coverage, including In-Network Rate, Allowed Amounts, and Prescription Drug files.
- Implement data validation, deduplication, and transformation logic to ensure high-quality extract files.
- Work with cloud platforms (Azure preferred) to optimize data pipelines.
- Design normalized and denormalized data models.
- Build FHIR-aligned structures.
- Support CMS interoperability API data requirements.
- Partner with Compliance and Product teams to meet all data requirements for Interoperability APIs and Machine Readable Files.
- Maintain documentation and data dictionaries.
- Work with vendor partners to map source data to FHIR R4 resources.
- Collaborate with Business Analysts, Governance, and DevOps teams.
Data Quality & Governance:
- Develop data quality rules and monitoring.
- Implement HIPAA-compliant data controls.
Required Qualifications
- Bachelor’s degree in computer science, Information Systems, Data Engineering, or related discipline.
- 3–7 years of data engineering experience in healthcare payer/provider/health-tech environment.
- Strong SQL development experience.
- Experience with ETL tools such as Azure Data Factory, SSIS, Informatica, and Databricks.
- Experience generating Machine Readable Files (TiC MRFs).
- Experience developing FHIR-ready extracts and familiarity with FHIR R4 structures.
- Understanding of healthcare data such as 837/835 claims, 834 eligibility, provider files, pharmacy claims.
- Experience with Git/GitHub and CI/CD workflows.
- Understanding of CMS interoperability regulations.
Preferred Qualifications
- Experience with Azure technologies (Data Lake, Synapse, Key Vault, Databricks).
- Experience with AMISYS or QNXT adjudication systems.
- Python, PySpark, or Scala programming experience.
- Familiarity with data governance frameworks such as DAMA or Collibra.
Key Competencies
- Excellent analytical and problem-solving skills.
- Strong communication skills.
- Ability to manage multiple projects in a fast-paced environment.
- Strong commitment to data quality and compliance
TULIT
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