Provide architecture and design for integrating Edifecs solutions into customer environment to meet customer business needs and technical needs for performance, scalability, maintainability and availability. Mentor implementation consultants and review work products/designs delivered by implementation consultants to ensure that they meet prescribed architecture. Provide software code and other artifacts for complex scenarios. Interface with Edifecs engineering team to understand product reference architecture and convert it into implementation architecture templates. Provide guidance to partners who are implementing Edifecs solution from time to time. Troubleshoot critical and complex issues in production that are escalated by support and implementation teams. Create reusable assets such as configuration templates, code templates and other extensions to product that can be leveraged across multiple implementations.

Solution & System Architecture

• Architect robust, scalable, and secure solutions across payer systems such as:
  • Claims Adjudication Engines (e.g., HealthRules Payor, QNXT, Facets)
  • Member Enrollment & Eligibility
  • Provider Data Management
  • Billing & Remittance Systems
• Define logical, physical, and integration architectures for service orchestration, and data flows.
• Develop architecture artifacts: solution blueprints, API/interface specifications, sequence diagrams and deployment models (cloud/hybrid).

Integration Design

• Design real-time and batch integrations using:
  • EDI (X12: 834, 837, 835, 270/271, 276/277, 278)
  • FHIR (CMS Interoperability APIs)
  • HL7 v2/v3
• Implement service-based integrations via RESTful APIs, SOAP Web Services, ESBs, and iPaaS platforms.
• Lead canonical data modeling and interface definition for intra-platform communication.

Cloud & Infrastructure

• Collaborate with DevOps and Infrastructure teams to deploy scalable solutions on:
  • AWS (EC2, Lambda, S3, RDS, API Gateway)
  • Azure (App Services, Logic Apps, Functions, Event Grid)
• Define containerization and orchestration strategies using Docker, Kubernetes, Helm for microservices deployment.

Data Strategy & Migration

• Develop data migration strategies for legacy-to-modern system transformations, ensuring data integrity, lineage, and auditability.
• Design ETL/ELT processes for payer data domains using Edifecs tools.
• Conduct performance tuning for high-volume transactional systems (claims and eligibility processing pipelines).
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Governance, Compliance & Security

• Ensure solutions are HIPAA-compliant.
• Implement role-based access controls (RBAC), encryption at rest and in transit, and OAuth2/OpenID protocols for FHIR APIs.
• Document architectural decisions using enterprise architecture tools (Sparx EA, ArchiMate, Visio).

Collaboration & Delivery

• Partner with business analysts, SMEs, and delivery leads to align technical design with payer business requirements.
• Serve as a hands-on technical lead during implementation, reviewing code, guiding developers, and conducting design reviews.
• Support Agile ceremonies (PI Planning, Sprint Reviews) and contribute to technical backlog grooming.

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.

Education and Experience:

• Bachelor’s degree or foreign equivalent degree in Computer Science, Engineering, or IT related field.
• 8 years of progressive, post-baccalaureate experience (within the past 8 years) in the healthcare industry as an Implementation Architect, Software Engineer, or related occupation.
• Hands-on experience with core payer platforms such as Facets, QNXT, HealthEdge, Epic Tapestry, or equivalent
• Deep understanding of healthcare interoperability standards (HL7 v2, HL7 FHIR, X12 EDI, NCPDP, C-CDA).

Technical Skills:

• Deep understanding of FHIR R4 structure, resource types, profiles, and terminology (LOINC, SNOMED, ICD).
• Familiarity with data formats: JSON, XML, HL7v2 messages, X12, flat files (CSV, pipe-delimited, etc.).
• Strong knowledge of Edifecs Applications.
• Strong knowledge of healthcare EDI transactions (834, 837, 835, 270/271, 278).
• Experience working with data ingestion and ETL pipelines in healthcare environments.
• Advanced proficiency with:
  • X12 EDI standards (834, 837, 835, 270/271, 278)
  • API design & integration (OpenAPI/Swagger, JSON, XML, REST)
  • FHIR, HL7, CDA, and modern healthcare interoperability standards
• Solid understanding of data modeling (logical & physical), relational databases (SQL Server, Oracle), and NoSQL (MongoDB, DynamoDB)
• Experience implementing solutions on AWS, Azure using CI/CD pipelines (GitLab, Jenkins, Terraform, CloudFormation)
• Experience with data integration platforms (MuleSoft, Mirth, Dell Boomi) and service-oriented architecture (SOA).
• Experience working in Agile or SAFe environments.
• Experience using integration engines or tools (e.g., Mirth Connect, InterSystems, AWS Glue, Talend) is a plus.
• 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. Soft Skills:
• 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.

Preferred Qualifications:

• Experience working with payer-provider interoperability use cases (e.g., Patient Access API, Provider Directory API).
• TOGAF, SAFe Architect, or similar architecture certification.
• AWS Certified Solutions Architect or equivalent cloud certification.
• Prior consulting or vendor-side implementation experience with health plans.
• 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.
• Experience automating data validation and transformation 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.
• Assessing the accuracy, neatness and thoroughness of the work assigned.
• Learning new tasks and completing tasks in situations that have a speed or productivity quota.
• Remembering and adhering to processes and protocols.
• Applying established protocols in a timely manner.

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 $120,000 to $156,000 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. 

Since this job will be based remotely, all interviews will be conducted virtually.

Date of posting: 11/7/2025
Applications are assessed on a rolling basis. We anticipate that the application window will close on 12/7/2025, 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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