Principal, Health Plan Integrations (Medtech)

TL;DR

Principal, Health Plan Integrations (Medtech): Leading and optimizing complex integrations for health plans and ecosystem partners, focusing on data accuracy, system configuration, and operational workflows within the healthcare domain. Focus on translating detailed business and clinical requirements into technical integration specifications and ensuring a seamless go-live experience for customers.

Location: Remote (US-based, operating across 48 states)

Salary: $150,000 – $190,000 USD

Company

hirify.global addresses the complexities of medical imaging by offering a concierge approach and a premium radiology network, reducing costs and ensuring fair prices for patients.

What you will do

• Act as a subject matter expert on end-to-end health plan operations and cross-departmental workflows.
• Lead integrations between health plan core systems (claims, enrollment, care management) and hirify.global.
• Define integration requirements for file-based exchanges (834, 835, 837, custom flat files) and real-time APIs.
• Partner with stakeholders to configure eligibility, benefits, claims rules, and medical management logic.
• Translate medical policy and benefit intent into executable system rules.
• Validate configurations through testing, UAT, and production readiness.

Requirements

• 8–10+ years of experience in health plan operations, healthcare IT, or healthcare implementations involving health plan integration.
• Strong understanding of EDI (834, 835, 837, 270, 271) and healthcare data flows and reconciliation.
• Direct, hands-on experience with core health plan systems (e.g., Facets, QNXT, HealthEdge, Epic Tapestry, Amisys).
• Ability to translate business and clinical requirements into technical integration specifications.
• Experience with eligibility & enrollment processing, claims configuration and adjudication, claims billing, and medical management systems.

Culture & Benefits

• Eligible to participate in equity incentive plans.
• Competitive benefits plans.
• Committed to diversity and equal employment opportunity.
• Provides accommodations for qualified individuals with disabilities in the recruiting process.