Lead Business Analyst

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 includes 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.

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.
• 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.
• 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 need
• 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

Education and Experience:

• 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).

Technical Skills:

• 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.

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).
• 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.
• Experience automating data validation and transformation processes.
• 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 $115,000 to $140,000 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.

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