Senior Business Analyst – Healthcare Interoperability

🕒 May 1

🇺🇸 United States – Remote

💵 $95k - $135k / year

⏰ Full Time

🟠 Senior

🧐 Business Analyst

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Cotiviti

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

⚕️ Healthcare Insurance

💳 Fintech

🤖 Artificial Intelligence

Healthcare Insurance • Fintech • Artificial Intelligence

Cotiviti is a healthcare technology and analytics company that specializes in improving payment accuracy and performance through advanced data analytics solutions. They partner with health plans, government agencies, and healthcare providers to deliver insights that enhance quality and efficiency in care delivery. With solutions such as risk adjustment, payment policy management, and member engagement, Cotiviti aims to optimize financial and clinical outcomes for the healthcare ecosystem.

📋 Description

• Analyze business needs related to healthcare data exchange and interoperability workflows • Analyze large volumes of raw healthcare data from multiple source systems including flat files, databases and formats (claims, member, provider, clinical, enrollment, financial) to assess structure, relationships, and consistency • Analyze relationships between data types (e.g., linking members to claims, providers to encounters) to ensure data accuracy and completeness • Led discovery and integration workshops with stakeholders across providers and payers to define interface specifications and data mappings • Developed functional and technical requirements for inbound and outbound interfaces i.e. healthcare data (HL7, FHIR, CDA, CCD, X12, etc.) specifications for development and integration teams • Interpret and document data integrity issues, bad data patterns, missing values, and duplication • Map and transform healthcare data into standardized formats (HL7 v2, HL7 FHIR, X12 EDI, CCD/C-CDA, proprietary formats) • Collaborate with internal and external stakeholders to gather data requirements and define technical specifications • Collaborate with stakeholders to understand business goals, integration needs, and compliance requirements • Work with integration teams to design streamlined, automated processes for exchanging data between payer, provider, and third-party systems • Ensure solutions comply with HIPAA, CMS interoperability rules, ONC guidelines, and other regulatory requirements • Partner with product managers, architects, and developers to ensure interoperability solutions meet business need • Develop and execute test cases for data transformations and integrations • Validate that data outputs align with both business rules and technical specifications • Validate data accuracy and integrity across systems using SQL and data profiling tools • Assist in root cause analysis and resolution of integration or data quality issues • Support UAT (User Acceptance Testing) for interoperability solutions and work with QA teams on test planning and validation • Monitor industry standards and regulations related to health data exchange and contribute to strategy and compliance initiatives • Assist development team with performance analysis and testing during release cycles for service packs, hot fixes etc. • Deliver a consistent, responsive and satisfying customer experience with each project • Mentored junior BA’s and conducted peer review of BRD’s, user stories and test plans

🎯 Requirements

• Bachelor's degree in health informatics, Computer Science, Data Science, Public Health, Information Systems, or a related field • 5+ years of experience as a Business/Data Analyst in healthcare, with a focus on interoperability or health data engineering • Deep understanding of healthcare interoperability standards (HL7 v2, HL7 FHIR, X12 EDI, NCPDP, C-CDA) • Deep understanding of FHIR R4 structure, resource types, profiles, and terminology (LOINC, SNOMED, ICD) • Experience working with data ingestion and ETL pipelines in healthcare environments • Proficiency in writing SQL queries for data validation and profiling • Familiarity with data formats: JSON, XML, HL7v2 messages, X12, flat files (CSV, pipe-delimited, etc.) • Experience using integration engines or tools (e.g., Mirth Connect, InterSystems, AWS Glue, Talend) is a plus • Knowledge of API-based data exchange (FHIR RESTful APIs) and SMART on FHIR concepts • Experience with HIE systems and clinical data repositories • Demonstrated experience analyzing large datasets (millions of rows) and complex multi-file healthcare data structures • Expertise with healthcare data domains: member, claims, provider, enrollment, and clinical data.

🏖️ Benefits

• medical, dental, vision, disability, and life insurance coverage • 401(k) savings plans • paid family leave • 9 paid holidays per year • 17-27 days of Paid Time Off (PTO) per year