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Payer Systems & Integration Architect

1 month, 3 weeks ago
United States
Full-time
Lead
Solutions Architect
Software Development
Apply Now
MCG Health

MCG Health

MCG Health, part of the Hearst Health network, independently develops evidence-based clinical guidelines and software solutions to support healthcare organizations in making informed care decisions. Their products are used by over 2,200 clients, includ...

Internet Software & Services
251-1K
Founded 1988
View All Jobs 8

Description

  • Serve as the principal subject matter expert and escalation authority for payer workflows, interoperability, integration architecture, and healthcare data flows.
  • Lead complex workflow discovery and implementation advisory engagements to define integration strategies and solution design.
  • Advise implementation teams and customers on how MCG solutions integrate into payer operational and technical ecosystems, including prior authorization workflows.
  • Identify and resolve workflow, interoperability, and integration risks, gaps, dependencies, and implementation challenges.
  • Partner cross-functionally with Product, Engineering, Implementation, Sales, and customer stakeholders to align design, dependencies, and execution.
  • Translate complex operational and technical concepts into clear guidance for technical teams, business stakeholders, and customers.
  • Facilitate working sessions with internal teams and customers on workflows, integration points, data dependencies, and implementation approaches.
  • Establish scalable implementation frameworks, standards, reusable assets, workflow models, and best practices.
  • Analyze recurring implementation issues to identify opportunities for process improvement, scalability, and operational efficiency.
  • Provide expert consultation, mentorship, and real-time integration guidance during customer engagements and pre-implementation discussions.
  • Develop knowledge aids and support cross-functional enablement for payer workflow and integration knowledge.
  • Use AI-enabled tools and technologies to improve implementation efficiency, documentation quality, and knowledge-sharing while maintaining accuracy and security.

Requirements

  • Bachelor’s degree in Healthcare Administration, Information Systems, Computer Science, Business, or a related field, or equivalent combination of education and experience.
  • At least 8 years of experience with health plan (payer) systems, workflows, operations, and healthcare integrations.
  • Experience leading or advising complex healthcare implementations, workflow transformations, or integration initiatives within payer environments.
  • Strong understanding of end-to-end healthcare workflows, particularly in payer operational settings.
  • Demonstrated expertise in healthcare interoperability, system integrations, and data flows across multiple platforms and technologies, including APIs, HL7, and FHIR.
  • Ability to analyze, interpret, and translate business, operational, and technical requirements into scalable implementation guidance.
  • Experience navigating highly complex or ambiguous payer operational and integration environments.
  • Experience working cross-functionally with technical, operational, product, and business stakeholders in matrixed environments.
  • Ability to diagnose complex workflow and integration issues and recommend scalable solutions.
  • Experience influencing technical and operational decisions without direct authority.
  • Strong communication skills with the ability to engage both technical and non-technical audiences.
  • Experience facilitating customer-facing discussions involving technical workflows, interoperability, and implementation strategy.
  • Knowledge of healthcare interoperability standards such as HL7 Da Vinci, FHIR, and X12 is preferred.
  • Knowledge of utilization management and prior authorization operational workflows is preferred.
  • Knowledge of provider system workflows and payer-provider interoperability considerations is preferred.
  • Experience developing implementation standards, frameworks, reusable methodologies, or operational best practices is preferred.
  • Strong written and verbal communication skills.
  • Strong problem-solving skills and ability to develop solutions beyond standard implementation approaches.
  • Ability to operate effectively in highly ambiguous and evolving environments.
  • Ability to collaborate across teams and influence stakeholders without direct authority.
  • Ability to facilitate alignment across technical, operational, and customer stakeholder groups.
  • Experience supporting organizational change, process improvement, or implementation scalability initiatives is preferred.

Benefits

  • Base salary range of $130,000 to $182,000.
  • Bonus eligible compensation.
  • Remote work with occasional travel.
  • Travel expected 1–3 trips per year for company-sponsored events, or 3–4 times per year depending on role needs.
  • Medical, dental, vision, life, and disability insurance.
  • 401(k) retirement plan with flexible spending and health savings account options.
  • 15 days of paid time off, plus additional front-loaded personal days.
  • 14 company-recognized holidays plus paid volunteer days.
  • Up to 8 weeks of paid parental leave plus 10 weeks of paid bonding leave.
  • LGBTQ+ Health Services and pet insurance.

Interested in this position?

Apply directly on the company website

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