Data Integration Manager

US Healthcare Data Integration - SME

Budget: 8-14 LPA

Experience- 5-8 yrs

About- empowers US healthcare payers with a truly next-generation, cloud-native, holistic, and customizable platform designed to prevent and adapt to the ever-evolving inaccuracies in healthcare claims and payments. By reducing complexity and administrative costs, we offer a unified, healthcare-dedicated platform backed by top VCs like BeeNext, 3One4 Capital, and Z21 Ventures

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Position Overview: We are looking for a US Healthcare Data Integration SME to support our Payment Integrity client onboarding and operations in the US Healthcare domain. The role involves comprehensive understanding of EDI, Healthcare Claim Form (Professional - 1500), (Facility - 1450), EDI maps for ANSI X12 transaction sets to claims model, Client claims data mapping, Data specs management, Data transformation, Data integration support, Data integrity validating, Data classification and Managing healthcare data from multiple sources to ensure accurate claims analysis, audit processes, and payment accuracy and support client onboardin

g.
Specialty Experti

se:Candidates must have proficiency in the following are

• as:Understanding of Revenue Cycle Management (RCM), US healthcare Claims & coding and billi
• ng.Healthcare Claim Form (Professional - 1500), (Facility - 1450) and EDI maps for ANSI X12 transaction se
• ts.Medical Codes: CPT/HCPCS, ICD, DRG, Modifiers e
• tc.Provider Data: NPI, Taxonomy Codes across all provide
• rs.Value sets: Standard value set in US healthca
• re.Data Integrity Validati
• on.Data classification Metholodologi
• es.Preferable, Clinical Data Exchange Understanding expertise in healthcare data exchange standards (HL7, FHIR,) and clinical terminologies (SNOMED, LOIN

C).
Key Responsibilit

• ies:EDI and Interoperability Leadership: Serve as the Subject Matter Expert (SME) for Electronic Data Interchange (EDI) and healthcare interoperability. Lead the full Software Development/Implementation/Onboarding Lifecycle (SDLC) for cross-functional projects, including requirements gathering, design, testing, implementation, and post-production supp
• ort.HIPAA X12 Specialization: Specialize in HIPAA-compliant X12 transactions, with a strong focus on the 837 (Healthcare Claim File), to support payment integrity operations, data workflows, and payer-provider or payer-payer data mapping and integrat
• ion.Data Specification Management: Design, develop, and maintain robust data claims model/Data Specification for healthcare claims and payment integrity systems for proof of concepts and Go-l
• ive.Data Sourcing and Transformation: Integrate data from multiple sources, including claims systems, payer platforms, and external healthcare datasets. Perform essential data mapping, transformation, and validation to ensure data accuracy and consiste
• ncy.Collaboration and Alignment: Partner closely with technical teams, business analysts, and client teams to ensure regulatory compliance, seamless system integration, and process automation. Work with Payment Integrity, Analytics, and Technology teams to support audit and automation initiati
• ves.Operational Excellence & Compliance: Monitor ETL processes and troubleshoot integration issues. Ensure strict compliance with HIPAA and data security standards when handling sensitive healthcare data. Act as the primary Data Integration liaison between Client and internal teams, driving timely resolution, system compliance, and stakeholder alignm

ent.
Data Quality & Improve

• ment:Timely Delivery: Ensure the timely and accurate processing of electronic and batch data f
• iles.Quality Improvement: Investigate and resolve errors and transaction failures, significantly improving data integrity and reducing exception r
• ates.Data Quality Checks: Support data quality checks and reconciliation to identify discrepancies in claims and payment
• data.Data Deficiency Impact Analysis: Collaborate with Business teams to unpackage impacted
• rulesData Integrity Library: Create, update and maintain Data integrity library for daily data validation c
• hecksDocumentations: Document data flows, mappings, and integration processes for each c
• lientOperational Efficiency: Contribute to operational efficiency through comprehensive documentation, root cause analysis, and continuous improvement initiat

ives.
Team Development & Mento

• rship:Trained and mentored junior analysts, supporting team professional development and enhancing perfor
• mance.Developed onboarding guides and mentoring programs to support team expansion and knowledge rete
• ntion.Co-develop automated tools with IT to correct transaction errors in real-time, eliminating multi-week d
• elays.Collaborated with developers and cross-functional teams to enhance workflow efficiency and optimize system integr

ation.
Client Communication: Data Inte

• grationCommunicate effectively with clients to address and resolve data-related queries indepen
• dently.Analyze and interpret client-reported data issues and provide appropriate sol
• utions.Assist clients in ensuring smooth and accurate data integration pro
• cesses.Proactively coordinate with clients to clarify requirements and maintain efficient data wor

kflows.
Requi

• rements:Strong understanding of US Healthcare data and claims processing wo
• rkflows.Experience working with healthcare claims datasets and payer
• systems.ANSI X12 transacti
• on sets.Claims Model mapping (EDI to Claims
• Model).Understanding of medical coding systems including CPT, HCPCS, ICD, and mo
• difiers.Familiarity with dataset policies and rules such as Medicare and Medicaid guidelines, pre
• ferable.Familiarity of standard healthcare value set, sch
• ema etc.Experience in data mapping, transformation logic, and integration docume
• ntation.Ability to analyze data requirements and translate them into data or busines
• s rules.Strong attention to data accuracy, consistency, and val
• idation.Ability to collaborate effectively with cross-functional teams in a fast-paced envi
• ronment.Strong analytical and problem-solving

skills.Qualifi

cations:Education & Certification (one of the following re

• quired):Bachelor's or Master's Degree in Computer Science, Data Science, Information Systems, or relat
• ed fieldMedical or Life Sciences background (MBBS, BDS, BPT, BAMS, Nursing, Pharmacy, Life S

ciences)Certification Requi

• rements:Pr
• eferableFHIR/HL7, EDI Certi
• ficationCertified Health Data Analys

t (CHDA)Exp

• erience:Experience in US Healthcare Data Integration (SME), US Healthcare Data Analysis with deep understanding of Claims model, EDI 837, X12, US healthcare Codesets and d

atasets.Key

• Skills:Data Integration & Data
• Mapping.Healthcare Claims Data A
• nalysis.Payment Integrity and Claims Adjudication Domain Kn
• owledge.Knowledge of code sets: CPT, HCPCS, ICD, DRG, PCS, Mo
• difiers.Understanding of Healthcare Claim Form (Professional - 1500), (Facility - 1450) and EDI maps for ANSI X12 transacti
• on sets.Strong proficiency in SQL, Python (Preferable), Microsoft Excel and data analysi
• s tools.Strong analytical, critical thinking, and problem-solving
• skills.Excellent written and verbal communication

skills.
Work Location: Jayanagar - B

angalore.
Work Mode: Work fr

om Office

• .
  Benefits:Best-in-class co
• mpensation.Health insurance
• for Family.Personal Accident
• Insurance.Friendly and Flexible Le
• ave Policy.Certification and Course Rei
• mbursement.Medical Coding CEUs and Membershi
• p Renewals.Heal
• th checkup.And