Business Analyst-HL7 and FHIR

Overview

We lead the industry in the breadth and depth of how we support our customers—by becoming an extension of their internal team. Helping our customers deliver world-class care and service is the Professional Services Team. The Professional Services team is seeking Business and Data Analyst – Healthcare Interoperability with strong expertise in healthcare interoperability to support large volume data-driven initiatives that improve healthcare data exchange and integration. This role will focus on understanding complex data sets — including member, claims, provider, clinical, and enrollment data — extracted from multiple source systems and spread across multiple data files. The analyst will assess data integrity, identify bad or incomplete data, map relationships between data elements, uncover patterns for process automation, and simplify integration between disparate healthcare platforms. Roles and Responsibilities include acting as a liaison between business stakeholders, technical teams, and application users to analyze workflows, translate data requirements, and ensure compliance with healthcare standards such as HL7, FHIR, CCD, and X12.

Responsibilities

• Analyze business needs related to healthcare data exchange and interoperability workflows.
• Interpret and document 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.
• Work with 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.
• 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.

This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change.

Qualifications

• Bachelor’s degree in health informatics, Computer Science, Data Science, Public Health, Information Systems, or a related field.
• 3–6 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.
• Strong analytical and problem-solving skills.
• Clear communication, with ability to document and explain complex technical concepts to stakeholders.
• Detail-oriented and highly organized, with a strong focus on data quality and compliance.
• Collaborative team player who can work across services, product, engineering, and business teams.
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