Interoperability Consultant

Interoperability Consultant

Location: Remote

Overview

We are seeking an experienced Interoperability Consultant with strong expertise in healthcare data exchange standards, payer operations, and regulatory frameworks (HIPAA, CMS, ONC). The ideal consultant will work closely with Payers, PBMs, and internal solution teams to translate regulatory and compliance requirements into scalable, technology-driven interoperability solutions.

Key Responsibilities

- Engage directly with Payers and PBMs to understand business needs, regulatory obligations, and integration requirements.

- Apply deep knowledge of HIPAA, CMS Interoperability & Prior Authorization Rules, ONC Cures Act, and healthcare compliance frameworks.

- Translate regulatory and compliance requirements into technical design, architectural recommendations, and FHIR-based interoperability solutions.

- Evaluate and identify appropriate interoperability solutions within the Prime ecosystem and ensure alignment with payer workflows.

- Participate in co-discovery and technical workshops, clearly articulating solution approach, data exchange models, and the PBM’s role in the interoperability landscape.

- Support teams in defining data flow, API models, authorization frameworks, and compliance checkpoints.

- Provide guidance on integrating FHIR APIs, patient access APIs, provider directory, and claims data exchange.

- Ensure interoperability solutions meet CMS, ONC, HIPAA, and security standards.

Required Skills & Experience

- Strong experience working with Payers, PBMs, or Healthcare Technology vendors.

- Deep understanding of HIPAA Privacy/Security Rule, CMS Interop & Prior Auth Final Rule, ONC Cures Act, and key compliance requirements.

- Hands-on experience with FHIR, HL7, APIs, payer interoperability workflows, or related technology frameworks.

- Excellent communication skills for interacting with clients, conducting workshops, and translating regulations into technical solutions.

Pay: $55.00 - $65.00 per hour

Expected hours: 40 per week

Work Location: Remote