Enterprise Healthcare Interoperability & Automation Engineer SME

Seeking an experienced Enterprise Healthcare Interoperability & Automation SME to join our team supporting Veterans. The Enterprise Healthcare Interoperability & Automation SME serves as the organization’s technical authority for healthcare interoperability, electronic data interchange (EDI), and transaction standards across multiple strategic healthcare modernization initiatives, including Community Care Network Next Generation (CCN NG), the VA Payer EDI Program, Veterans Financial Management Platform (VFMP) Modernization, Edifecs implementation and optimization efforts, and future interoperability initiatives.

This role is responsible for interpreting healthcare transaction standards, implementation guides, companion guides, business requirements, and interoperability frameworks, transforming them into reusable engineering assets, business rules, and technical guidance that enable successful integration across the enterprise. The Enterprise Healthcare Interoperability Engineer leverages intelligent automation and AI-assisted engineering practices to accelerate standards analysis, business rule development, impact assessments, and engineering workflows while ensuring all outputs remain traceable, governed, and subject to appropriate human review.

Working as a member of the Synthetic Data & Automation Engineering Team while supporting enterprise interoperability initiatives, the Enterprise Healthcare Interoperability Engineer partners with enterprise architects, software engineers, business stakeholders, product teams, and program leadership to ensure healthcare transaction processing remains standards-conformant, interoperable, and aligned with evolving regulatory and business requirements.

This individual serves as the organization’s trusted advisor for healthcare interoperability, providing technical leadership that extends beyond any single application or modernization effort., Enterprise Interoperability Leadership

• Serve as the organization’s subject matter expert for healthcare interoperability and electronic data interchange (EDI).
• Provide technical guidance supporting enterprise interoperability initiatives, including CCN Next Generation, VA Payer EDI, VFMP Modernization, Edifecs implementation and optimization, and future modernization efforts.
• Advise engineering teams and program leadership on interoperability strategies, standards adoption, and integration best practices.
• Promote consistency, standardization, and reuse across enterprise interoperability initiatives.
• Champion the responsible adoption of AI-assisted engineering practices and intelligent automation to improve interoperability analysis, standards implementation, and engineering productivity.

Standards Engineering

• Interpret ANSI X12 implementation guides, companion guides, regulatory guidance, and healthcare interoperability standards.
• Translate business and regulatory requirements into reusable engineering specifications, business rules, technical reference materials, and interoperability patterns.
• Develop and maintain enterprise transaction models supporting healthcare information exchange.
• Assess the impact of evolving standards and recommend implementation strategies.
• Leverage AI-assisted analysis techniques to accelerate interpretation of implementation guides, companion guides, and evolving interoperability standards while ensuring technical accuracy through expert review.
• Develop reusable prompts, knowledge assets, and engineering patterns that improve consistency and efficiency across interoperability initiatives.

Business Rule Engineering

• Develop reusable business rule libraries supporting healthcare transaction processing, synthetic data generation, integration validation, and automation.
• Define enterprise reference scenarios covering standard processing, exception handling, boundary conditions, and edge cases.
• Maintain traceability between business requirements, transaction standards, engineering assets, and operational outcomes.
• Collaborate with automation and engineering teams to develop machine-readable business rule libraries supporting intelligent automation, synthetic data generation, and enterprise integration validation.
• Identify opportunities to automate repetitive standards interpretation and business rule engineering activities using AI-assisted engineering workflows and modern automation technologies.

Platform & Solution Support

• Partner with the Synthetic Data & Automation Engineering Team to ensure engineering platforms accurately represent enterprise healthcare business processes.
• Support interoperability analysis for enterprise integration platforms, including Edifecs and successor technologies.
• Contribute to companion guide development, transaction validation strategies, and interoperability testing approaches.
• Assist engineering teams in resolving complex interoperability issues and transaction processing challenges.
• Partner with engineering teams to integrate interoperability knowledge into intelligent automation workflows, synthetic data generation, and automated integration validation capabilities.
• Support development of AI-enabled engineering assets that improve interoperability analysis, traceability, and engineering consistency across the enterprise.

Governance & Modernization

• Monitor emerging interoperability standards, regulatory changes, and industry best practices.
• Participate in Architecture of Alternatives (AoA), technology evaluations, and modernization planning related to healthcare interoperability platforms.
• Evaluate emerging AI capabilities, automation technologies, and interoperability tools for practical application within enterprise healthcare modernization initiatives.
• Establish best practices for the responsible use of AI-assisted engineering techniques while maintaining regulatory compliance, transparency, traceability, and human oversight.
• Recommend improvements that strengthen enterprise interoperability, automation, and engineering efficiency.
• Support development of enterprise interoperability governance, standards, reference architectures, and reusable engineering assets.

Collaboration

• Partner with enterprise architects, solution architects, software engineers, business analysts, data engineers, and external stakeholders.
• Serve as the technical liaison between business organizations and engineering teams for interoperability-related initiatives.
• Work closely with engineering teams to identify opportunities where automation and AI-assisted engineering can reduce implementation effort, improve interoperability quality, and accelerate delivery.
• Promote knowledge sharing and development of reusable interoperability assets across programs.
• Mentor engineers and analysts on healthcare interoperability standards, engineering best practices, and emerging technologies., * Establish enterprise interoperability standards and reusable business rule assets supporting multiple healthcare modernization initiatives.
• Improve consistency of healthcare transaction implementation across CCN NG, VA Payer EDI, VFMP Modernization, and related interoperability efforts.
• Develop reusable interoperability guidance, companion guide interpretations, engineering patterns, and knowledge assets that reduce implementation effort across projects.
• Establish AI-assisted engineering practices and intelligent automation patterns that improve consistency, traceability, and engineering productivity while maintaining governance and human oversight.
• Reduce the time required to assess and implement new interoperability requirements through reusable engineering assets, intelligent automation, and AI-assisted analysis.
• Support enterprise decision-making regarding interoperability technologies, including Edifecs optimization, modernization, or replacement strategies.
• Partner with engineering teams to ensure synthetic data, automation platforms, and integration validation capabilities accurately reflect enterprise healthcare transaction processing.
• Serve as the organization’s trusted technical advisor for healthcare interoperability, helping drive modernization while maintaining standards compliance, interoperability, operational consistency, and engineering excellence.

• Demonstrated expertise with ANSI X12 healthcare transaction standards, including 837, 835, 270/271, and related transaction sets.
• Extensive experience interpreting healthcare implementation guides and companion guides.
• Experience translating business requirements into reusable technical specifications, engineering assets, or business rule models.
• Strong understanding of healthcare claims, eligibility, provider, payment, and interoperability workflows.
• Experience collaborating across multidisciplinary engineering teams.
• Excellent analytical, communication, facilitation, and stakeholder engagement skills.

Desired Skills and Qualifications:

• Experience supporting federal healthcare programs, including the Department of Veterans Affairs (VA), Centers for Medicare & Medicaid Services (CMS), Department of Defense (DoD), or commercial healthcare organizations
• Experience supporting enterprise EDI modernization initiatives or payer transaction processing.
• Experience with Edifecs implementation, configuration, optimization, governance, or technology evaluation.
• Experience supporting Architecture of Alternatives (AoA) or technology modernization initiatives
• Experience supporting synthetic data generation or enterprise data management initiatives
• Familiarity with HL7 FHIR, APIs, and modern healthcare interoperability frameworks
• Experience applying AI-assisted engineering tools and intelligent automation to improve engineering workflows
• Experience working within Agile software development environments.

Desired Technical Skills

• ANSI X12 Healthcare Transactions
• Healthcare implementation guides and companion guides
• Healthcare claims, eligibility, and payment processing
• Enterprise EDI and interoperability architecture
• Business rule engineering
• Requirements analysis and traceability
• HL7 FHIR and API-based interoperability
• Intelligent automation and AI-assisted engineering
• Synthetic data concepts
• Systems integration
• Agile software engineering
• Requirements and knowledge management platforms

Education and Experience:

• Master’s degree in Health Information Management, Information Systems, Computer Science, Healthcare Administration, Software Engineering, or a related technical discipline, or equivalent professional experience.
• Ten (10) years of experience with Seven (7) or more years of progressive experience supporting healthcare interoperability, healthcare integration, EDI transaction processing, or enterprise integration initiatives.

HigherEchelon, Inc. (HE) is a service-disabled veteran-owned small business (SDVOSB) organizational performance consulting firm with offerings in Engineering, Gaming, Human Capital, Enterprise Technology and Cyber Solutions. HigherEchelon aims to be the premier trusted partner in organizational excellence and achieves this through sustained investment in talent and the employee experience. HigherEchelon puts the employee first to better serve customer needs and sustain excellence.

HigherEchelon offers competitive full-time benefits including paid vacation and holidays, 401(k) matching, full health/dental/vision coverage, plus much more. For on-site and remote employees, flexible work schedules are offered when authorized.

By joining our team, you are choosing to embark on a journey towards excellence as a valued team member and trusted partner. We appreciate your inquiry and look forward to discussing the opportunity further.

EOE/Minorities/Females/Veterans/Disabled:

HigherEchelon, Inc. is an Equal Employment Opportunity employer and provides reasonable accommodation for qualified individuals with disabilities and disabled veterans in its job application procedures.