About the Role :

We are seeking a highly experienced Techno-Functional Lead to drive IT project management for web and mobile application development initiatives serving USA-based healthcare provider and payor clients. This senior role requires deep domain expertise in healthcare operations combined with strong technical acumen in modern application architecture, systems integration, APIs, AI/ML, and full-stack technologies. The ideal candidate will act as the bridge between business stakeholders and technology teams, translating complex healthcare workflows into scalable, compliant digital solutions.

Roles & Responsibilities :

1. Healthcare Domain Consulting Payor & Provider :

- Provide deep functional expertise in provider operations: clinical workflows, RCM, credentialing, scheduling, EMR/EHR integration, patient engagement.

- Act as domain expert for payor operations: claims processing, enrollment & eligibility, prior authorization, utilization management, care management, member services.

- Translate US healthcare business requirements into functional specifications, user stories, and process flows.

- Conduct workshops and discovery sessions with stakeholders to capture requirements and validate solution design.

2. Technical Architecture & Integration Consulting :

- Guide application architecture for healthcare web and mobile platforms (front-end, back-end, middleware, cloud).

- Oversee integrations with EHR/EMR systems (Epic, Cerner, Athenahealth), payer platforms, clearinghouses, and third-party vendors.

- Define API strategy (REST, SOAP, FHIR, HL7) for interoperability.

- Advise on middleware patterns (ESB, Kafka, RabbitMQ, microservices).

- Collaborate with UI/UX teams on front-end (React, Angular) and mobile (iOS, Android, React Native).

- Provide oversight on back-end stacks (.NET, Java, Node.js, Python).

- Guide AI/ML use cases: clinical decision support, prior authorization automation, NLP for coding, predictive analytics, patient/member engagement.

3. IT Project Management Support :

- Define scope, timelines, and deliverables for healthcare IT engagements.

- Participate in Agile ceremonies: sprint planning, backlog grooming, reviews.

- Conduct gap analysis, feasibility studies, and impact assessments.

- Prepare/review BRDs, SRDs, solution design documents, and integration specs.

- Manage and mentor onshore-offshore teams, ensuring quality delivery.

- Liaise with USA-based stakeholders, ensuring clear communication across time zones.

Required Skills :

1. Domain Expertise :

- 15+ years in IT, with 8-10 years in US Healthcare IT.

- Proven expertise in payor operations: claims adjudication, EOB/ERA, EDI 837/835/270/271/278, prior authorization workflows, provider/member experience.

- Strong knowledge of provider operations: CRM, clinical data management, RCM, charge capture, coding (ICD 10, CPT, HCPCS), billing, collections, provider portals.

- Hands-on with healthcare data standards: HL7 v2.x, HL7 FHIR R4, CCD/CDA, DICOM, X12 EDI.

- Understanding of US healthcare regulations: HIPAA, HITECH, 21st Century Cures Act, TEFCA, CMS Interoperability Rule.

2. Technical Expertise :

- Web application architecture: microservices, REST APIs, serverless, containerization (Docker/Kubernetes).

- Full-stack environments: React/Angular (front-end), .NET Core/C#, SQL/NoSQL databases.

- Mobile applications: native (iOS/Android), cross-platform (React Native, Flutter).

- Integration with EHR/EMR platforms and payer systems.

- Middleware/integration platforms: Azure API Management, Logic Apps, Service Bus.

- AI/ML awareness: LLMs, NLP for clinical text, predictive modeling, AI-driven care management.

- Cloud: Azure (HIPAA-compliant architectures).

- DevOps/CI-CD: Agile/Scrum, JIRA, Confluence, Git, automated testing pipelines.

Preferred Qualifications :

- Salesforce certifications such as Administrator, CPQ Specialist, Service Cloud Consultant, or Field Service Consultant.

- Exposure to ITIL practices in support environments.

Pay range and compensation package :

- Competitive salary based on experience and qualifications.

Equal Opportunity Statement :

- We are an equal opportunity employer and are committed to creating a diverse and inclusive workplace.

- We encourage applications from all qualified individuals regardless of race, gender, age, sexual orientation, disability, or any other characteristic protected by law.

Qualification :

- Bachelors degree in computer science, Information Technology, Engineering, or a related field.