Senior Healthcare Clearinghouse & Payer Integration Architect

Role - Senior Healthcare Clearinghouse & Payer Integration Architect

Location Remote

Tentative Duration - 4 - 6 months

Job description

1. 10+ years of Healthcare IT experience with deep expertise in Claims, ERA/EOB, Remittance, Eligibility, and Provider-Payer workflows.
2. Hands-on experience with clearinghouses, including onboarding, connectivity, and transaction processing.
3. Expert knowledge of EDI transactions, including 835 ERA, 837P/I/D Claims, 270/271 Eligibility, 276/277 Claim Status, EFT, and remittance workflows. ( EDI Corrections, Charging Corrections, Downcoding)
4. Strong understanding of Waystar and Availity API capabilities, including bulk retrieval, file exchange, trading partner setup, SFTP integrations, and API-based automation.
5. Experience designing enterprise-scale integrations across multiple clearinghouses and payer ecosystems, with the ability to define a unified payer connectivity strategy.
6. Hands-on experience integrating with commercial payer portals such as UHC, UMR, Optum, BCBS plans, Molina, UPMC, Oscar, Ambetter, GEHA, and similar provider portals.
7. Expertise in designing automated EOB, ERA, and remittance retrieval solutions using APIs, EDI integrations, RPA, or portal automation technologies.
8. Experience with automation platforms such as UiPath, Power Automate, Playwright, Selenium, or custom automation frameworks for payer portals that do not expose APIs.
9. Ability to evaluate and recommend payer integration architecture, including API-first, EDI-based, clearinghouse-mediated, and portal automation approaches while addressing security, scalability, and compliance requirements.
10. Proven track record serving as a Healthcare Integration SME, providing architecture guidance, vendor assessments, feasibility studies, and implementation leadership for payer, clearinghouse, and revenue cycle transformation initiatives.