Job Title: Project Manager / Business Analyst – Healthcare Interoperability & Claims (837/835/276/277, Medicare & Medicaid)
Location: Remote (United States)
Employment Type: Contract, Long-Term (W2)
Pay Rate: $30–$60/hr (W2), based on experience
Posted by: TAP Innovations, LLC
Overview
TAP Innovations is placing a senior Project Manager / Business Analyst with a client building a cloud-based healthcare platform for skilled nursing and senior living operators. The platform covers the clinical record, healthcare data exchange, and the full medical billing cycle. This is a hands-on role for someone who can run delivery and write the requirements. It is not a generalist PM seat. The client intends this to be a long-term engagement.
What You'll Do
- Plan and run delivery of interoperability and claims features: scope, milestones, dependencies, risks, and release readiness.
- Run sprint ceremonies and backlog grooming with a distributed engineering team.
- Coordinate clearinghouse onboarding, payer and EDI enrollment, and trading partner testing.
- Report status to client leadership: what is on track, what is at risk, and what decision is needed.
- Perform current-state and gap analysis of billing, claims, and data-exchange workflows in skilled nursing and senior living.
- Turn payer rules, companion guides, and Medicare/Medicaid policy into user stories, acceptance criteria, process maps, and data mappings.
- Define requirements across the claim lifecycle: eligibility (270/271), authorization (278), claim submission (837I/837P), acknowledgements (TA1, 999, 277CA), claim status (276/277), and remittance (835).
- Specify Medicare logic (Part A skilled stays, PDPM/HIPPS, consolidated billing, Part B, Medicare Advantage) and Medicaid logic (state variation, patient liability, managed Medicaid).
- Define coordination of benefits for dual-eligible residents, plus denial management and A/R requirements (CARC/RARC, timely filing, aging).
- Gather requirements for Health Information Exchange (HIE) and apply Health Information Management (HIM) principles.
- Work with engineers on FHIR, HL7 v2, and C-CDA data flows, and on the code sets that join clinical and billing data.
- Contribute to solution design with engineering: claim status model, denial and rework queues, remittance posting, and A/R reporting.
- Plan and run UAT with operational users and validate the implementation before release.
Required Skills & Experience
- Bachelor's degree.
- 7+ years of combined project management and business analysis experience, with at least 5 years in healthcare.
- Hands-on medical claims processing with X12 transactions (837, 835, 276/277) and their acknowledgements.
- Strong knowledge of Medicare and Medicaid financials, including how Medicare and Medicaid coordinate for dual-eligible patients.
- Experience with healthcare interoperability: HIE and HIM.
- Proven ability to write requirements engineers can build from: user stories, acceptance criteria, process flows, and data mappings.
- Agile delivery experience with Jira, Azure DevOps, or equivalent.
- Excellent communication with executives, clinicians, billing staff, and engineers.
- Must reside in the US and be authorized to work in the US. Excellent written and verbal English required.
Strong Plus
- Skilled nursing, long-term care, post-acute, or senior living experience (MDS 3.0, PDPM, UB-04, Medicaid patient liability).
- PointClickCare, MatrixCare, or similar long-term care EHR/billing platforms.
- Clearinghouse experience (Availity, Waystar, Optum/Change Healthcare), including payer enrollment and trading partner testing.
- Working knowledge of FHIR R4, HL7 v2, and C-CDA.
- Exposure to state Medicaid MMIS, managed Medicaid, or Medicare Advantage authorization workflows.
- PMP, CSM/PSM, CBAP, CRCR, CPB, RHIA, or RHIT.
Work Conditions
- Remote within the US; US business hours, working with a distributed engineering team.
- No travel expected.
- Protected health information is never placed in tickets, logs, screenshots, or sample files.
TAP Innovations is an Equal Opportunity Employer. All qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, disability, veteran status, or any other protected characteristic.
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