Sr Business Analyst - Healthcare Interoperability

This a Full Remote job, the offer is available from: United States Overview: Provides analysis of quantitative and qualitative data from internal and external data sources in support of business decisions. Job Duties: Uses standard or ad hoc queries or reports to extract data from disparate databases or data sources. Analyzes data to produce dashboards, metrics, or insights and identify trends or anomalies. Consults with users or decision makers to identify data sources, required data elements, or data validation standards. Collaborates with development teams to design business intelligence solutions to facilitate data gathering, storage, and retrieval. Experience and Education: Performs work under minimal supervision. Handles complex issues and problems, and refers only the most complex issues to higher-level staff. Possesses comprehensive knowledge of subject matter. Reports to: Typically reports to a department head or manager. Competencies: Oral and written communication skills. Problem/situation analysis. Ability to identify and seek needed information/research skills. Analytical thinking skills. Statistical knowledge. Technical expertise. Mathematical skills.

• Responsibilities:
• 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

This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change.

• Qualifications:
• 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