Job Title: Healthcare Interoperability & Compliance SME (X12 278 / FHIR / CMS-57F)
Location: Remote
Duration: 3 Months (Contract)
Workload Note: 20 hours/week in Month 1, then 40 hours/week from Month 2 onward
Years of Experience Required: 8+ years in Healthcare IT
Education Background: Bachelor s or Master s in Computer Science, Information Systems, Healthcare Informatics, or related field
Domain/Industry: Healthcare IT / Interoperability / Regulatory Compliance
Interview Details: Virtual Technical + Panel discussions
Extension / Full-Time Possibility
- Contract extension beyond the initial 3 months is possible based on performance and business need
- Potential for long-term engagement; full-time conversion is not guaranteed
Must / Top Required Skills
- 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
Job Description (JD)
We are seeking a Healthcare Interoperability Subject Matter Expert (SME) to support regulatory compliance and guide implementation teams in healthcare data exchange solutions.
The SME will:
- 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.
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