Senior Healthcare Data Integration Engineer

Insight Global
Newtown, United States of America
8 days ago

Role details

Contract type
Permanent contract
Employment type
Full-time (> 32 hours)
Working hours
Regular working hours
Languages
English
Experience level
Senior

Job location

Newtown, United States of America

Tech stack

Data analysis
C Sharp (Programming Language)
ETL
UN Electronic Data Interchange for Administration Commerce and Transport
SQL Server Integration Services
Sql Optimization
Data Lake
Integration Frameworks
Databricks

Job description

We are seeking a Senior Healthcare Data Integration Engineer to work on the Exchange Encounter & Risk Adjustment team. This person will support healthcare payer operations focused on ACA Exchange Risk Adjustment, CMS EDGE submissions, encounter data quality, and healthcare data integration. This is a hands-on technical leadership role responsible for troubleshooting complex healthcare data issues, improving encounter data quality, supporting CMS EDGE processes, and partnering across business, IT, data, and vendor teams. This is not a project management role.

  • Lead technical troubleshooting of encounter and risk adjustment data issues

  • Analyze CMS EDGE submission errors and drive resolution

  • Support encounter reconciliation, validation, and error remediation activities

  • Partner with business, operations, data, IT, and vendor teams

  • Improve encounter acceptance rates and overall data quality

Requirements

Strong experience with SSIS, ETL, and C#

-Healthcare background, specifically with CMS/Medicare/Medicaid

-Strong understanding of healthcare payer data, including:

o Claims

o Encounters

o Enrollment

o Diagnosis data

  • Advanced SQL skills for data analysis, validation, and troubleshooting

  • Experience with healthcare EDI transactions

  • Experience with healthcare integration platforms such as:

o Edifecs

o IBM ITX (Transformation Extender)

o Similar healthcare EDI/integration tools

  • Proven ability to troubleshoot complex healthcare data pipelines and submission issues * HHS-HCC Risk Adjustment experience

  • Direct experience supporting ACA Exchange Risk

Adjustment

  • Hands-on experience with CMS EDGE Server

submissions, reconciliation, validation, and error remediation

  • Encounter acceptance/rejection analysis

  • CMS audit support

  • Data quality improvement initiatives

  • Healthcare data warehouse or data lake environments

  • Databricks or cloud-based healthcare data platforms

  • Technical leadership or mentoring experience

  • Vendor management experience

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