- Education & Experience: Bachelor’s or advanced degree in computer science, health informatics, or related field.
- 10+ years of experience in healthcare IT, including substantial hands-on work in interoperability/integration.
- 5+ years of deep experience with HL7 FHIR (FHIR R4 or later) and related healthcare data standards.
- FHIR & CQL Mastery: Expert-level knowledge of the FHIR standard (resources, profiles, RESTful API, etc.) and the Clinical Quality Language. Comfortable reading and authoring CQL logic for clinical quality measures.
- Experience using or implementing a CQL execution engine.
- Quality Measures & Standards: Understanding of healthcare quality measurement programs and standards.
- Knowledge of NCQA HEDIS® measures and the transition from traditional reporting to digital quality measures (dQMs).
- Interoperability Implementation Guides: Demonstrated experience with or strong knowledge of relevant FHIR Implementation Guides and exchange frameworks. This includes US Core profiles (the U.S. baseline FHIR profiles for EHR data), QI-Core (FHIR profiles for quality improvement), and others like FHIR Bulk Data and Carin Blue Button for payer data.
- Technical Skills: Strong architecture and software engineering skills related to data exchange.
- Proficiency in designing and consuming RESTful APIs in .NET, C# and working with JSON/XML healthcare data.
- Experience with FHIR client/server implementations or FHIR data stores. Understanding of healthcare data security and consent, including OAuth2/OpenID Connect for API security and HIPAA compliance considerations.
- Hands-on ability with query languages or data processing (SQL, etc.).
- Soft Skills: Excellent communication and stakeholder management abilities.
- Proven ability to work cross-functionally – collaborating with product managers, clients, clinicians, and engineers.
- Able to translate regulatory/clinical requirements into technical solutions and explain technical concepts to non-technical audiences.
- Strong problem-solving mindset and a track record of driving initiatives from concept to implementation.
- Experience in an Agile development environment, with skills in breaking down complex projects and prioritizing requirements.
- Leadership and mentorship capabilities are essential – this role will guide teams and represent Cotiviti’s interoperability expertise both internally and externally, so the candidate should be comfortable taking initiative, “leading without authority” when required, and mentoring others.
Preferred Qualifications:
- Prior experience working with quality measurement or population health data is highly desirable.
- Familiarity with FHIR data models and how they represent clinical concepts for quality measurement.
- Any experience with cloud-based health data services (AWS, GCP, or Azure healthcare APIs) is a plus.
- Advanced FHIR Engagement: Participation in HL7 FHIR community activities (e.g., HL7 workgroups, FHIR Connectathons, Da Vinci Project workgroups). Any HL7 or NCQA certifications, such as HL7 FHIR Proficiency/Certification or NCQA’s Digital Quality perspectives, would be a strong plus.
- Direct involvement in developing or testing digital quality measures or interoperability solutions.
- Software & Tools: Experience with tools used in quality measurement or health data integration, such as measure authoring/testing tools (CMS MADiE ), clinical data integration engines, or analytics platforms.
- Familiarity with data warehousing or big data processing of healthcare information (e.g., using Spark or Hadoop for large EHR data sets) is a plus.
- Any prior work with AI/ML in healthcare data.
- Domain Expertise: Working knowledge of HEDIS is a plus.
Cognitive / Mental Requirements:
- Excellent communication and stakeholder management abilities.
- Able to translate regulatory/clinical requirements into technical solutions and explain technical concepts to non-technical audiences.
- Strong problem-solving mindset and a track record of driving initiatives from concept to implementation.
- Leadership and mentorship capabilities are essential – this role will guide teams and represent Cotiviti’s interoperability expertise both internally and externally, so the candidate should be comfortable taking initiative, “leading without authority” when required, and mentoring others.
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 a dedicated, secure work area.
- Must be able to provide high-speed internet access / connectivity and office setup and maintenance.
Base compensation ranges from $140,000 to $165,000 per year. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. This role is eligible for discretionary bonus consideration.
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.
This role is based remotely and all interviews will be conducted virtually.
Date of posting: 10/09/2025
Applications are assessed on a rolling basis. We anticipate that the application window will close on 01/08/2025, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.
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