Cotiviti leads the industry in the breadth and depth of how we support our customers—by becoming an extension of their internal teams. The Professional Services team is seeking a Lead Business Analyst with deep expertise in healthcare interoperability to drive strategic, data-driven initiatives that improve healthcare data exchange and integration.This role will lead cross-functional efforts to analyze complex healthcare datasets—claims, member, provider, clinical, and enrollment data—across disparate systems. The Lead BA will define integration strategies, ensure compliance with evolving standards, and deliver solutions that support world-class care and service.

• Lead stakeholder workshops to define business needs, data requirements, and integration specifications.
• Translate complex healthcare workflows into actionable requirements, ensuring alignment with standards like HL7, FHIR, CCD, and X12.
• Analyze large healthcare datasets (claims, member, provider, clinical, enrollment) to assess structure, relationships, and data quality.
• Identify and resolve data integrity issues, including missing values, duplication, and inconsistent formats.
• Define and document functional and technical specifications for data interfaces and transformations.
• Map and standardize healthcare data across formats (HL7 v2, FHIR, X12 EDI, CCD/C-CDA).
• Collaborate with internal and external teams to design automated, scalable data exchange processes.
• Ensure compliance with HIPAA, CMS interoperability rules, ONC guidelines, and other regulatory standards.
• Develop and execute test cases; validate data outputs against business rules and technical specs.
• Support UAT and assist in resolving integration and data quality issues.
• Mentor junior analysts and review documentation for accuracy and completeness.
• Represent Cotiviti at industry events to stay current on interoperability trends and contribute to strategic initiatives.

• Bachelor’s degree in Health Informatics, Computer Science, Data Science, Public Health, Information Systems, or related field.
• 7–10 years of experience as a Business Analyst in healthcare, with a focus on interoperability or health data engineering, including:
  • Deep understanding of healthcare interoperability standards: HL7 v2, HL7 FHIR, X12 EDI, NCPDP, C-CDA
  • Expertise in FHIR R4 structure, resource types, profiles, and terminology (LOINC, SNOMED, ICD)
  • Experience with data ingestion and ETL pipelines in healthcare environments
  • Proficiency in SQL for data validation and profiling
  • Familiarity with data formats: JSON, XML, HL7v2, X12, CSV, pipe-delimited
  • Experience with integration tools (e.g., Mirth Connect, InterSystems, AWS Glue, Talend)
  • Knowledge of API-based data exchange (FHIR RESTful APIs) and SMART on FHIR
  • Experience with HIE systems and clinical data repositories
  • Demonstrated ability to analyze large datasets and complex multi-file healthcare data structures
  • Expertise with healthcare data domains: member, claims, provider, enrollment, and clinical data

Preferred Qualifications:

• Experience working with payer-provider interoperability use cases (e.g., Patient Access API, Provider Directory API).
• Familiarity with TEFCA, QHIN, HIE, CARIN, USCDI, and other national health data initiatives.
• Background in clinical workflows, health IT systems (e.g., Epic, Cerner), claims data or UM systems (guiding care, MCG, InterQual).
• Exposure to cloud platforms (e.g., AWS, Azure) and healthcare data storage frameworks.
• Experience with cloud-based data platforms (AWS, Azure, GCP) and data integration tools (MuleSoft, Boomi, Informatica, Talend).
• Familiarity with big data frameworks (Spark, Databricks) or advanced ETL/ELT processes.

Cognitive/ Mental Requirements:

• Communicating with others to exchange information.
• Problem-solving and thinking critically.
• Completing tasks independently.
• Interpreting data.
• Making timely decisions in the context of a workflow.
• Maintaining focus.

Physical Requirements and Working Conditions:

• 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 high-speed internet access / connectivity and office setup and maintenance.
• Must be able to provide a dedicated, secure work area.

Base compensation ranges from $76,000 to $94,000 per year. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs.

Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.

Date of posting: x/xx/2025

Applications are assessed on a rolling basis. We anticipate that the application window will close on x/xx/2025, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.

#LI-MJ1

#LI-Remote