Job Description
Job Title: Healthcare Interoperability & Compliance SME (X12 278 / FHIR / CMS-57F)
Location: Remote
- Duration: 3 Months (Contract) – Expected extension possible but not guaranteed
- Workload Note: 20 hours/week in Month 1, then 40 hours/week from Month 2 onward
Years of Experience Required: 8+ years in Healthcare IT
Visa Status: US Citizen or Green Card only
Education Background: Bachelor’s or Master’s in Computer Science, Information Systems, Healthcare Informatics, or related field
Domain/Industry: Healthcare IT / Interoperability / Regulatory Compliance
Interview Details: Virtual – Technical + Panel discussions
- Candidate Disqualifiers
- No candidates from JNTU University
- Extension / Full-Time Possibility
- Possible extension beyond 3 months depending on project needs
- Potential conversion to full-time not guaranteed
- Must / Top Required Skills
- Deep hands-on knowledge of X12 EDI 278 Prior Authorization transactions
- Strong experience with HL7 FHIR (R4 preferred), APIs, and implementation guides
- Proven expertise in CMS-57F compliance and interoperability mandates
- Understanding of payer-provider workflows, utilization management, and prior authorization processes
- Experience with EHR/EMR systems, clearinghouses, and payer platforms
- Ability to translate CMS regulations into technical and functional requirements
- Excellent communication skills for technical and non-technical stakeholders
Job Description (JD)
- We are seeking a Healthcare Interoperability Subject Matter Expert (SME) to support regulatory compliance and guide implementation teams in healthcare data exchange solutions. The SME will:
- Serve as SME for X12 278 Prior Authorization workflows (inbound/outbound transactions, acknowledgments, error handling).
- Provide expert guidance on HL7 FHIR standards and CMS regulations.
- Ensure compliance with CMS-57F mandates, including prior authorization requirements and interoperability timelines.
- Translate CMS regulations into actionable technical and functional requirements.
- Participate in design reviews, architecture discussions, and audits.
- Review mapping documents, data models, and integration flows for compliance and accuracy.
- Collaborate with product owners, architects, developers, QA, and client stakeholders.
- Provide guidance on best practices for interoperability, security, and data governance.
- Support documentation, compliance artifacts, and knowledge transfer activities.
Remote
Skills:
Application Programming Interface (API), Best Practices, Communication Skills, Computer Science, Content Management Systems (CMS), Data Mapping, Data Modeling, Documentation Models, Electronic Data Interchange (EDI), Electronic Medical Records, Error Handling, HL7 (Health Level 7), Health Informatics, Health Information Technology, Healthcare, Information Technology & Information Systems, Interoperability, Interoperability Requirements, Maintain Compliance, Medical Record System, People Management, Quality Assurance, Regulations, Regulatory Compliance, United States Citizen, Utilization Management
About the Company:
FL Tech Solutions LLC
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