Payer Systems & Integration Architect
MCG Health2 months ago
Base Salary
$130k - $182k/yr
Responsibilities
- Serve as the principal subject matter expert and escalation authority for payer workflows, interoperability, integration architecture, and healthcare data flows.
- Lead complex workflow discovery and implementation advisory engagements across diverse payer environments.
- Advise implementation teams and customers on solution integration, utilization management workflows, and prior authorization processes.
- Identify and resolve complex workflow, interoperability, integration, dependency, and implementation risks.
- Partner with Product, Engineering, Implementation, Sales, and customer stakeholders on solution design and implementation strategy.
- Facilitate working sessions and translate complex operational and technical concepts for technical and non-technical audiences.
- Develop scalable implementation frameworks, standards, reusable assets, workflow models, and best practices.
- Analyze recurring implementation challenges and provide feedback to Product and Engineering teams.
- Provide functional leadership, mentorship, customer strategy guidance, knowledge aids, and cross-functional enablement.
- Use AI-enabled tools appropriately to improve implementation efficiency, workflow analysis, documentation, and knowledge sharing.
Requirements
- Bachelor’s degree in Healthcare Administration, Information Systems, Computer Science, Business, or a related field, or an equivalent combination of education and experience.
- At least 8 years of experience with health plan payer systems, workflows, operations, and healthcare integrations.
- Experience leading or advising complex healthcare implementations, workflow transformations, or integration initiatives in payer environments.
- Strong understanding of end-to-end payer healthcare workflows and healthcare interoperability.
- Expertise with system integrations and data flows across multiple platforms and technologies, including APIs, HL7, FHIR, or related standards.
- Ability to translate business, operational, and technical requirements into scalable implementation guidance and solution approaches.
- Experience navigating complex or ambiguous payer operational and integration environments and developing solution strategies.
- Experience working cross-functionally with technical, operational, product, and business stakeholders in matrixed environments.
- Experience diagnosing complex workflow and integration issues and influencing decisions without direct authority.
- Strong communication and customer-facing facilitation skills with technical and non-technical audiences.
- Preferred knowledge of HL7 Da Vinci, FHIR, X12, utilization management, prior authorization, provider workflows, and payer-provider interoperability.
- Preferred experience developing implementation standards, frameworks, reusable methodologies, process improvements, or organizational scalability initiatives.
Benefits
- Remote work with occasional travel for company-sponsored events; the posting states travel expectations of approximately 1–3 trips per year and elsewhere 3–4 times per year.
- Medical, dental, vision, life, and disability insurance.
- 401(k) retirement plan, flexible spending account, and health savings account.
- 15 days of paid time off plus additional front-loaded personal days.
- 14 company-recognized holidays and paid volunteer days.
- Up to 8 weeks of paid parental leave plus 10 weeks of paid bonding leave.
- LGBTQ+ health services and pet insurance.
Categories
Solutions Engineering