Sr Business Analyst - Healthcare Interoperability

Cotiviti is a company focused on healthcare data solutions, and they are seeking a Senior Business Analyst specializing in healthcare interoperability. The role involves analyzing healthcare data exchange workflows, collaborating with stakeholders to define data requirements, and ensuring compliance with healthcare regulations.

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

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)
• 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
• Ability to work independently as well as collaborate as a team with a sense of urgency
• Professional with the ability to properly handle confidential information
• Be value-driven, understand that success is based on the impact of your work rather than its complexity or the level of effort
• Ability to handle multiple tasks, prioritize, and meet deadlines
• Flexibility to work with global teams as well as geographically dispersed US-based teams
• Remaining in a stationary position, often standing or sitting for prolonged periods
• Repeating motions that may include the wrists, hands, and/or fingers
• Must be able to provide a dedicated, secure work area
• Must be able to provide high-speed internet access/connectivity and office setup and maintenance