Healthcare Interoperability Engineer - HL7 FHIR / Prior Authorization

Role: Healthcare Interoperability Engineer - HL7 FHIR / Prior Authorization Location: United States (Remote) Duration: Long term Contract Experience: 5+ years in Healthcare IT, including 3+ years of hands-on HL7 FHIR implementation Job Summary We are seeking a Senior Healthcare Interoperability Engineer with strong expertise in HL7 FHIR, CMS interoperability mandates, and Prior Authorization modernization. The ideal candidate should have hands-on experience implementing CMS-0057-F, HL7 Da Vinci Implementation Guides, and payer-provider interoperability solutions. This role requires a strong understanding of both the technical implementation and business workflows supporting Prior Authorization in the US healthcare ecosystem. Key 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: o CRD (Coverage Requirements Discovery) o DTR (Documentation Templates and Rules) o PAS (Prior Authorization Support) o 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. Required Skills • Healthcare & Regulatory • 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. HL7 FHIR & Interoperability • 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. Technical Skills • 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 • Add on advantage if the person knows databases and Cloud Preferred Qualifications • 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. We are specifically seeking candidates with proven experience implementing CMS interoperability mandates, HL7 Da Vinci Prior Authorization Implementation Guides (CRD, DTR, PAS), and Prior Authorization workflows within the US healthcare ecosystem.