Interoperability & Data Integration Consultant

• How ADT feeds move from Epic and Cerner to health plans: HL7v2 (MLLP/SFTP), FHIR Subscriptions, and HIE-mediated approaches
• The end-to-end data flow from an ED admission event at a health system to a matched member record at an MCO
• Health information exchange (HIE) infrastructure: what state and regional HIEs can and cannot do as intermediaries
• Data use agreements, BAAs, and the contracting process required to establish data-sharing relationships with provider organizations
• Member-matching logic: how ADT events map to health plan enrollment and eligibility files
• Clinical classification of ED visits (NYU Algorithm, Billings, AHRQ PQI) to distinguish emergent from non-emergent utilization
• The realities of working across health systems with varying EHR platforms and levels of technical maturity

Do you have experience in Systems integration?, Mizzeto is seeking a consultant with strong knowledge of how clinical data-specifically ADT (Admit-Discharge-Transfer) feeds-flows from hospital EHR systems (Epic, Cerner) to health plans. We need someone who understands the architecture, integration pathways, and the operational and contractual landscape involved in payer-provider data exchange., * 7+ years in healthcare IT, health plan operations, or health information exchange

• Strong working knowledge of how ADT feed integrations are established between provider health systems and payer organizations
• Payer-side experience: Medicaid MCO, Medicare Advantage, or D-SNP in an interoperability, population health, or care management role
• Understanding of HL7v2 ADT messaging, FHIR-based interoperability standards, and HIE infrastructure
• Familiarity with the contracting and regulatory landscape for health system data sharing, including CMS Interoperability rule requirements

PREFERRED:

• Experience at a Medicaid MCO or national managed care organization
• Familiarity with claims platforms (QNXT, Facets) and care management system integration points
• Background in ED diversion, avoidable ED, or high-utilizer intervention programs
• Knowledge of how different health systems and EHR vendors approach data sharing with payers