Healthcare Interoperability Engineer - HL7 FHIR / Prior Authorization

Kastech Software Solutions Group is seeking a Senior Healthcare Interoperability Engineer with expertise in HL7 FHIR and Prior Authorization modernization. The role involves designing and implementing healthcare interoperability solutions while collaborating with various teams to translate regulatory requirements into scalable technical solutions.

Responsibilities:

• Design and implement healthcare interoperability solutions using HL7 FHIR R4 and RESTful APIs
• Implement CMS-0057-F Prior Authorization Final Rule and other CMS interoperability requirements
• Implement HL7 Da Vinci Implementation Guides, including:
• CRD (Coverage Requirements Discovery)
• DTR (Documentation Templates and Rules)
• PAS (Prior Authorization Support)
• Experience with PDex, HRex, Plan Net, Formulary, and ATR is highly preferred
• Design, develop, and support FHIR APIs using core FHIR resources including Patient, Practitioner, Organization, Coverage, Coverage Eligibility, Claim, ClaimResponse, ServiceRequest, Encounter, CarePlan, Observation, Procedure, DiagnosticReport, MedicationRequest, Task, and Communication
• Integrate payer, provider, authorization, claims, member, and clinical systems using healthcare interoperability standards
• Implement secure interoperability using SMART on FHIR, OAuth 2.0, OpenID Connect, JWT, and CDS Hooks
• Collaborate with business, clinical, product, and engineering teams to translate regulatory requirements into scalable technical solutions
• Participate in solution architecture, API design, testing, deployment, and production support

Requirements:

• 5+ years in Healthcare IT, including 3+ years of hands-on HL7 FHIR implementation
• Strong expertise in HL7 FHIR, CMS interoperability mandates, and Prior Authorization modernization
• Hands-on experience implementing CMS-0057-F, HL7 Da Vinci Implementation Guides, and payer-provider interoperability solutions
• Strong understanding of both the technical implementation and business workflows supporting Prior Authorization in the US healthcare ecosystem
• Design and implement healthcare interoperability solutions using HL7 FHIR R4 and RESTful APIs
• Implement CMS-0057-F Prior Authorization Final Rule and other CMS interoperability requirements
• Design, develop, and support FHIR APIs using core FHIR resources including Patient, Practitioner, Organization, Coverage, Coverage Eligibility, Claim, ClaimResponse, ServiceRequest, Encounter, CarePlan, Observation, Procedure, DiagnosticReport, MedicationRequest, Task, and Communication
• Integrate payer, provider, authorization, claims, member, and clinical systems using healthcare interoperability standards
• Implement secure interoperability using SMART on FHIR, OAuth 2.0, OpenID Connect, JWT, and CDS Hooks
• Collaborate with business, clinical, product, and engineering teams to translate regulatory requirements into scalable technical solutions
• Participate in solution architecture, API design, testing, deployment, and production support
• Strong understanding of the US Healthcare payer and provider ecosystem
• Hands-on experience with Prior Authorization workflows
• Knowledge of claims, eligibility, coverage, clinical, and authorization processes
• Experience implementing CMS interoperability initiatives, including CMS-0057-F
• Knowledge of Medicare, Medicaid, HIPAA, and healthcare regulations
• Strong hands-on experience with HL7 FHIR R4
• Experience developing and consuming RESTful FHIR APIs
• Strong understanding of FHIR resources, profiles, extensions, validation, search, and Bulk FHIR
• Experience with SMART on FHIR, OAuth 2.0, OpenID Connect, JWT, and CDS Hooks
• Experience with one or more of the following: Coding Experience Java/Python/.net
• Good knowledge on REST APIs, JSON / XML, OpenAPI / Swagger, API Gateways, Microservices
• Experience working with US Healthcare Payers or Providers
• Hands-on implementation of HL7 Da Vinci Prior Authorization solutions
• Experience integrating X12 278 with FHIR PAS
• Knowledge of EDI 270/271, 276/277, 837, and 835 transactions
• Experience with integration platforms such as MuleSoft, Boomi, Talend, or Azure Integration Services
• HL7 FHIR Certification is a plus