FLG -190 - Healthcare Interoperability & Compliance SME - 100% Remote

Hello,

Good morning,

We Floga Technologies are a growing IT services organization delivering scalable technology solutions and are expanding our team with qualified talent.

We have Immediate opening for a Healthcare Interoperability & Compliance SME with strong hands-on experience to support a long-term engagement with our client. Must be able to work collaboratively with cross-functional teams to deliver high-quality solutions.

Role: Healthcare Interoperability & Compliance SME (X12 278 / FHIR / CMS-57F)

Location: 100% Remote

Duration: Long Term

Role Summary

We are seeking a Healthcare Interoperability Subject Matter Expert (SME) with strong hands-on experience in X12 278 transactions, HL7 FHIR standards, and CMS-57F compliance. The SME will support regulatory compliance, guide implementation teams, and ensure healthcare data exchange solutions align with CMS and industry standards.

Key Responsibilities

Serve as SME for X12 278 (Prior Authorization) workflows, including inbound/outbound transactions, acknowledgments, and error handling.

Provide expert guidance on HL7 FHIR standards, including FHIR resources, APIs, profiles, and implementation guides relevant to CMS regulations.

Ensure solution compliance with CMS-57F mandates, including Prior Authorization requirements and interoperability timelines.

Interpret CMS regulations and translate them into technical and functional requirements for delivery teams.

Support design reviews, architecture discussions, and solution validation to ensure regulatory adherence.

Collaborate with product owners, architects, developers, QA, and client stakeholders.

Review mapping documents, data models, and integration flows for compliance and accuracy.

Assist with client discussions, audits, and regulatory readiness assessments.

Provide guidance on best practices for healthcare interoperability, security, and data governance.

Support documentation, compliance artifacts, and knowledge transfer activities.

Required Skills & Experience

8+ years of experience in healthcare IT with strong domain expertise.

Deep hands-on knowledge of X12 EDI, specifically 278 Prior Authorization transactions.

Strong experience with HL7 FHIR (R4 preferred), FHIR APIs, and implementation guides.

Proven experience supporting CMS-57F compliance and CMS interoperability mandates.

Understanding of payer-provider workflows, utilization management, and prior authorization processes.

Experience working with EHR/EMR systems, clearinghouses, and payer platforms.

Ability to translate regulatory requirements into technical and functional solutions.

Excellent communication skills to work with both technical and non-technical stakeholders.

Preferred Qualifications

Experience with CMS Interoperability and Prior Authorization Final Rule implementations.

Familiarity with OAuth 2.0, SMART on FHIR, and healthcare security standards.

Exposure to cloud-based healthcare platforms (Azure, AWS, Google Cloud Platform).

Experience supporting large payer or healthcare transformation programs.

Prior experience in client-facing SME or consulting roles.