US Healthcare Data Integration - SME

**Job Description:** **Role Overview:** As a US Healthcare Data Integration Subject Matter Expert (SME) at CoverSelf, you will be responsible for supporting Payment Integrity client onboarding and operations in the US Healthcare domain. Your role will involve a comprehensive understanding of EDI, Healthcare Claim Form, data mapping, transformation, and integration to ensure accurate claims analysis, audit processes, and payment accuracy for our clients. **Key Responsibilities:** - **EDI and Interoperability Leadership:** - Serve as the SME for Electronic Data Interchange (EDI) and healthcare interoperability. - Lead the full Software Development/Implementation/Onboarding Lifecycle (SDLC) for cross-functional projects. - Design, testing, implementation, and post-production support. - **HIPAA X12 Specialization:** - Specialize in HIPAA-compliant X12 transactions, focusing on the 837 Healthcare Claim File. - Support payment integrity operations, data workflows, and payer-provider data mapping. - **Data Specification Management:** - Design, develop, and maintain robust data claims model/Data Specification for healthcare claims and payment integrity systems. - **Data Sourcing and Transformation:** - Integrate data from multiple sources, perform data mapping, transformation, and validation. - Ensure data accuracy and consistency. - **Collaboration and Alignment:** - Partner closely with technical teams, business analysts, and client teams. - Ensure regulatory compliance, seamless system integration, and process automation. - **Operational Excellence & Compliance:** - Monitor ETL processes, troubleshoot integration issues, and ensure compliance with HIPAA and data security standards. - Act as the primary Data Integration liaison between Client and internal teams. **Data Quality & Improvement:** - **Timely Delivery:** - Ensure timely and accurate processing of electronic and batch data files. - Investigate and resolve errors, significantly improving data integrity. - **Data Quality Checks:** - Support data quality checks and reconciliation. - Identify discrepancies in claims and payment data. - **Data Deficiency Impact Analysis:** - Collaborate with Business teams to analyze impacted rules. - **Documentation:** - Document data flows, mappings, and integration processes for each client. - **Operational Efficiency:** - Contribute to operational efficiency through comprehensive documentation and continuous improvement initiatives. **Team Development & Mentorship:** - **Trained and Mentored Junior Analysts:** - Support team professional development and enhance performance. - **Developed Onboarding Guides:** - Create mentoring programs to support team expansion and knowledge retention. - **Collaboration with Developers:** - Enhance workflow efficiency and optimize system integration. **Client Communication: Data Integration:** - **Effective Communication:** - Address and resolve data-related queries independently. - Analyze client-reported data issues and provide solutions. - **Data Integration Coordination:** - Coordinate with clients to clarify requirements and maintain efficient data workflows. **Qualification Required:** - **Education & Certification:** - Bachelors or Masters Degree in Computer Science, Data Science, Information Systems, or related field. - Medical or Life Sciences background preferred. - **Certification Requirements:** - FHIR/HL7, EDI Certification. - Certified Health Data Analyst (CHDA). - **Experience:** - Experience in US Healthcare Data Integration and Analysis. - Deep understanding of Claims model, EDI 837, X12, US healthcare Codesets. - **Key Skills:** - Data Integration & Data Mapping. - Healthcare Claims Data Analysis. - Payment Integrity and Claims Adjudication Domain Knowledge. - Proficiency in SQL, Python, Microsoft Excel, and data analysis tools. **About CoverSelf:** CoverSelf empowers US healthcare payers with a next-generation, cloud-native, holistic platform designed to prevent inaccuracies in healthcare claims and payments. We offer a unified, healthcare-dedicated platform backed by top VCs like BeeNext, 3One4 Capital, and Z21 Ventures. At CoverSelf, we are committed to diversity and providing equal opportunities for all employees. **Job Description:** **Role Overview:** As a US Healthcare Data Integration Subject Matter Expert (SME) at CoverSelf, you will be responsible for supporting Payment Integrity client onboarding and operations in the US Healthcare domain. Your role will involve a comprehensive understanding of EDI, Healthcare Claim Form, data mapping, transformation, and integration to ensure accurate claims analysis, audit processes, and payment accuracy for our clients. **Key Responsibilities:** - **EDI and Interoperability Leadership:** - Serve as the SME for Electronic Data Interchange (EDI) and healthcare interoperability. - Lead the full Software Development/Im