Techno functional Lead

About the Company

We are seeking a highly experienced Techno-Functional Lead to drive IT project management for web and mobile application development initiatives serving USA-based healthcare provider and payor clients. This senior role requires deep domain expertise in healthcare operations combined with strong technical acumen in modern application architecture, systems integration, APIs, AI/ML, and full-stack technologies. The ideal candidate will act as the bridge between business stakeholders and technology teams, translating complex healthcare workflows into scalable, compliant digital solutions.

About the Role

Healthcare Domain Consulting – Payor & Provider

• Provide deep functional expertise in provider operations: clinical workflows, RCM, credentialing, scheduling, EMR/EHR integration, patient engagement.
• Act as domain expert for payor operations: claims processing, enrollment & eligibility, prior authorization, utilization management, care management, member services.
• Translate US healthcare business requirements into functional specifications, user stories, and process flows.
• Conduct workshops and discovery sessions with stakeholders to capture requirements and validate solution design.

Responsibilities

Technical Architecture & Integration Consulting

• Guide application architecture for healthcare web and mobile platforms (front-end, back-end, middleware, cloud).
• Oversee integrations with EHR/EMR systems (Epic, Cerner, Athenahealth), payer platforms, clearinghouses, and third-party vendors.
• Define API strategy (REST, SOAP, FHIR, HL7) for interoperability.
• Advise on middleware patterns (ESB, Kafka, RabbitMQ, microservices).
• Collaborate with UI/UX teams on front-end (React, Angular) and mobile (iOS, Android, React Native).
• Provide oversight on back-end stacks (.NET, Java, Node.js, Python).
• Guide AI/ML use cases: clinical decision support, prior authorization automation, NLP for coding, predictive analytics, patient/member engagement.

IT Project Management Support

• Define scope, timelines, and deliverables for healthcare IT engagements.
• Participate in Agile ceremonies: sprint planning, backlog grooming, reviews.
• Conduct gap analysis, feasibility studies, and impact assessments.
• Prepare/review BRDs, SRDs, solution design documents, and integration specs.
• Manage and mentor onshore-offshore teams, ensuring quality delivery.
• Liaise with USA-based stakeholders, ensuring clear communication across time zones.

Qualifications

• 15+ years in IT, with 8–10 years in US Healthcare IT.
• Proven expertise in payor operations: claims adjudication, EOB/ERA, EDI 837/835/270/271/278, prior authorization workflows, provider/member experience.
• Strong knowledge of provider operations: CRM, clinical data management, RCM, charge capture, coding (ICD 10, CPT, HCPCS), billing, collections, provider portals.
• Hands-on with healthcare data standards: HL7 v2.x, HL7 FHIR R4, CCD/CDA, DICOM, X12 EDI.
• Understanding of US healthcare regulations: HIPAA, HITECH, 21st Century Cures Act, TEFCA, CMS Interoperability Rule.

Required Skills

• Web application architecture: microservices, REST APIs, serverless, containerization (Docker/Kubernetes).
• Full-stack environments: React/Angular (front-end), .NET Core/C#, SQL/NoSQL databases.
• Mobile applications: native (iOS/Android), cross-platform (React Native, Flutter).
• Integration with EHR/EMR platforms and payer systems.
• Middleware/integration platforms: Azure API Management, Logic Apps, Service Bus.
• AI/ML awareness: LLMs, NLP for clinical text, predictive modeling, AI-driven care management.
• Cloud: Azure (HIPAA-compliant architectures).
• DevOps/CI-CD: Agile/Scrum, JIRA, Confluence, Git, automated testing pipelines.