[Hiring] Senior Business Analyst - Healthcare Interoperability @Cotiviti

Role Description

Provides analysis of quantitative and qualitative data from internal and external data sources in support of business decisions.

• Uses standard or ad hoc queries or reports to extract data from disparate databases or data sources.
• Analyzes data to produce dashboards, metrics, or insights and identify trends or anomalies.
• Consults with users or decision makers to identify data sources, required data elements, or data validation standards.
• Collaborates with development teams to design business intelligence solutions to facilitate data gathering, storage, and retrieval.
• Performs work under minimal supervision.
• Handles complex issues and problems, referring only the most complex issues to higher-level staff.
• Possesses comprehensive knowledge of subject matter.

Responsibilities

• Analyze business needs related to healthcare data exchange and interoperability workflows.
• Analyze large volumes of raw healthcare data from multiple source systems including flat files, databases and formats (claims, member, provider, clinical, enrollment, financial) to assess structure, relationships, and consistency.
• Analyze relationships between data types (e.g., linking members to claims, providers to encounters) to ensure data accuracy and completeness.
• Led discovery and integration workshops with stakeholders across providers and payers to define interface specifications and data mappings.
• Developed functional and technical requirements for inbound and outbound interfaces i.e. healthcare data (HL7, FHIR, CDA, CCD, X12, etc.) specifications for development and integration teams.
• Interpret and document data integrity issues, bad data patterns, missing values, and duplication.
• Map and transform healthcare data into standardized formats (HL7 v2, HL7 FHIR, X12 EDI, CCD/C-CDA, proprietary formats).
• Collaborate with internal and external stakeholders to gather data requirements and define technical specifications.
• Collaborate with stakeholders to understand business goals, integration needs, and compliance requirements.
• Work with integration teams to design streamlined, automated processes for exchanging data between payer, provider, and third-party systems.
• Ensure solutions comply with HIPAA, CMS interoperability rules, ONC guidelines, and other regulatory requirements.
• Partner with product managers, architects, and developers to ensure interoperability solutions meet business needs.
• Develop and execute test cases for data transformations and integrations.
• Validate that data outputs align with both business rules and technical specifications.
• Validate data accuracy and integrity across systems using SQL and data profiling tools.
• Assist in root cause analysis and resolution of integration or data quality issues.
• Support UAT (User Acceptance Testing) for interoperability solutions and work with QA teams on test planning and validation.
• Monitor industry standards and regulations related to health data exchange and contribute to strategy and compliance initiatives.
• Assist development team with performance analysis and testing during release cycles for service packs, hot fixes etc.
• Deliver a consistent, responsive and satisfying customer experience with each project.
• Mentored junior BA’s and conducted peer review of BRD’s, user stories and test plans.

Qualifications

• Bachelor’s degree in health informatics, Computer Science, Data Science, Public Health, Information Systems, or a related field.
• 5+ years of experience as a Business/Data Analyst in healthcare, with a focus on interoperability or health data engineering.
• Deep understanding of healthcare interoperability standards (HL7 v2, HL7 FHIR, X12 EDI, NCPDP, C-CDA).
• Deep understanding of FHIR R4 structure, resource types, profiles, and terminology (LOINC, SNOMED, ICD).
• Experience working with data ingestion and ETL pipelines in healthcare environments.
• Proficiency in writing SQL queries for data validation and profiling.
• Familiarity with data formats: JSON, XML, HL7v2 messages, X12, flat files (CSV, pipe-delimited, etc.).
• Experience using integration engines or tools (e.g., Mirth Connect, InterSystems, AWS Glue, Talend) is a plus.
• Knowledge of API-based data exchange (FHIR RESTful APIs) and SMART on FHIR concepts.
• Experience with HIE systems and clinical data repositories.
• Demonstrated experience analyzing large datasets (millions of rows) and complex multi-file healthcare data structures.
• Expertise with healthcare data domains: member, claims, provider, enrollment, and clinical data.

Physical Requirements and Working Conditions

• Flexibility to work with global teams as well as geographically dispersed US-based teams.
• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• Must be able to provide a dedicated, secure work area.
• Must be able to provide high-speed internet access/connectivity and office setup and maintenance.

Benefits

• Base compensation ranges from $95,000 to $135,000 per year.
• Cotiviti offers a competitive benefits package including medical, dental, vision, disability, and life insurance coverage.
• 401(k) savings plans.
• Paid family leave.
• 9 paid holidays per year.
• 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti.