Job Overview
The organization is actively implementing federal interoperability mandates under CMS-0057-F (Interoperability and Prior Authorization Final Rule). These rules require the organization to implement and maintain Patient Access APIs, Provider Directory APIs, Provider Access APIs, Payer-to-Payer APIs, and Prior Authorization APIs based on HL7 FHIR standards.
The organization's interoperability environment relies on Infor Cloverleaf as the primary integration engine, MarkLogic as the data store, and FHIR-based APIs for data exchange with multiple external partners including managed care organizations (MCOs), providers, payers, and state and federal agencies.
The organization exchanges health data with multiple external sources and maintains a complex portfolio of HL7 and FHIR-based healthcare interfaces. These interfaces require ongoing management, optimization, documentation, and governance to ensure accurate, reliable, and compliant data exchange.
Existing interfaces require a comprehensive current-state assessment, standardized documentation, and a structured process improvement program to ensure they meet current standards and are optimized for performance and reliability.
The purpose of this Statement of Work (SOW) is to procure staff augmentation services for one (1) Lead Interface & Interoperability Analyst to provide senior-level technical leadership for healthcare interface operations, interoperability compliance activities, interface documentation and process improvement, document management, and small team leadership.
Key Duties
- Manage daily healthcare interface operations, ensuring availability, accuracy, and performance of all data exchange processes across Cloverleaf and FHIR API environments.
- Monitor, triage, and resolve interface errors, message failures, and data exchange issues; coordinate with trading partners as needed to restore normal operations.
- Develop and maintain comprehensive interface documentation including interface specifications, data flow maps, SOPs, and operational runbooks.
- Continue current-state assessment of all existing interfaces; identify and implement optimization opportunities to improve performance, reliability, and standards compliance.
- Support CMS-9115-F and CMS-0057-F compliance activities including FHIR API testing, validation, documentation, and go-live support.