Job Summary :

The FHIR Analyst will be a subject matter expert in implementing and maintaining interoperability solutions in compliance with the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F).

This role requires an in-depth understanding of FHIR standards, data mapping, and API development within the payer and provider domains.

The analyst will work closely with business, compliance, and IT teams to ensure the organization meets all regulatory deadlines and improves data exchange for prior authorizations, patient access, and payer-to-payer data transfer.

Key responsibilities

- Regulatory analysis and interpretation : Analyze and interpret the CMS-0057-F rule and related FHIR Implementation Guides (IGs), such as CARIN BB, US Core, Da Vinci PDEX, and Da Vinci CRD, DTR, and PAS, to translate complex regulatory requirements into detailed technical specifications.

- Requirements gathering : Collaborate with product managers, product owners, operational, and technical stakeholders to define the business and data requirements for implementing new FHIR-based APIs and updating existing ones.

- Data mapping and modeling : Perform in-depth data analysis and mapping exercises, linking proprietary source system data to the appropriate FHIR resources and profiles, as well as integration with Electronic Health Records (EHRs), such as Epic and Cerner, using FHIR APIs.

- FHIR API implementation support : Assist development teams in the design, development, and testing of the following FHIR-based APIs mandated by CMS-0057-F :

- Prior Authorization API : Enable the electronic exchange of prior authorization requests and responses between payers and providers.

Technical Skills :

- FHIR Standards & Implementation Guides : R4, DSTU2; CARIN BB, US Core, Da Vinci PDEX, CRD, DTR, PAS.

- API Development & Integration : Hands-on experience with RESTful APIs, JSON, XML, and FHIR-based integrations.

- EHR Systems : Experience integrating with Epic, Cerner, or similar healthcare systems.

- Data Mapping & Modeling : Expertise in mapping healthcare data from proprietary systems to FHIR resources.

- Regulatory Knowledge : Strong understanding of CMS Interoperability rules (CMS-0057-F) and prior authorization requirements.

- Testing Tools : Postman, Inferno, Touchstone, or other FHIR testing frameworks.

- Additional Skills : Version control, scripting for data validation, and documentation best practices.

Education & Qualifications :

- Bachelors or Masters degree in Computer Science, Information Technology, Health Informatics, or a related field.

- 3 to 7 years of experience in healthcare interoperability, FHIR implementation, or health IT systems