JOB SUMMARY
The Senior IT Business Analyst (Interoperability) acts as the primary bridge between business strategy and technical execution. You will design, validate, and implement healthcare data exchange solutions for our health plan. This role collaborates heavily with Databricks development teams to transform complex EDI data into actionable analytics assets while ensuring absolute regulatory compliance.
Key Responsibilities
Requirement Engineering: Lead discovery sessions with clinical, billing, and network operations to map healthcare data pipelines.
Data Mapping & Design: Author detailed data mapping specifications converting legacy formats into modern cloud data lake models.
Databricks Collaboration: Partner with data engineers to translate business logic into optimized PySpark or SQL transformation pipelines.
Standards Enforcement: Serve as the subject matter expert for healthcare data exchange compliance across all internal platforms.
Testing & Validation: Define comprehensive test scenarios, validate complex payloads, and coordinate End-to-End user acceptance testing.
Required Qualifications
EDI X12 Expertise: Advanced proficiency in processing and translating 837 (Claims), 834 (Enrollment), 835 (Remittance), and 270/271 (Eligibility) files - 8+ years of experience
Databricks Ecosystem: Strong familiarity with Delta Lake concepts, Medallion Architecture (Bronze/Silver/Gold), and Unity Catalog governance - 6+ years of experience
Data Querying: Exceptional SQL skills to analyze multi-million row datasets, write complex joins, and audit pipeline data quality - 6+ years of experience
Interoperability Standards: Deep working knowledge of CMS Interoperability rules, HL7 v2/v3, and FHIR resource structures.
Payer Operations: Direct experience working within a health plan environment, including strong grasp of claims pricing and enrollment logic.
Experience: Minimum 8+ years of IT Business Analysis experience, with at least 4 years dedicated to healthcare interoperability.
Agile Delivery: Proven success operating in fast-paced Scrum or Kanban environments, owning Jira epics and story decomposition.
Bridging the Gap: Rare ability to explain highly complex X12 looping structures to developers, and technical Databricks limitations to business stakeholders.
