EliteSquad.AI
Website:
elitesquad.ai
Job details:
Job Description: Solution Architect – US Healthcare
Position: Solution Architect
Experience: 15+ Years Overall | 12+ Years in US Healthcare
Location: Remote
Domain: US Healthcare
Technology: .NET, Java, Cloud, APIs, Microservices, Healthcare Integration
Share your CV at SANJAY.C@ELITESQUAD.AI
About the Role
We are looking for a highly experienced Solution Architect with 15+ years of overall IT experience and at least 12 years of hands-on experience in the US Healthcare domain. The ideal candidate will have strong expertise in both Microsoft .NET and Java technologies and a deep understanding of the end-to-end US Healthcare ecosystem, including healthcare payers, providers, claims, enrollment, eligibility, benefits, billing, pharmacy/PBM, healthcare interoperability, integrations, and regulatory requirements. This role requires an architect who can bridge the gap between business requirements, healthcare domain processes, enterprise architecture, application architecture, integration architecture, data architecture, security, and cloud infrastructure. The candidate should have a proven track record of designing and delivering large-scale, highly available, secure, scalable, and compliant healthcare solutions for US-based healthcare organizations.
Responsibilities
- Solution & Enterprise Architecture
- Define end-to-end solution architecture for complex healthcare applications and enterprise platforms.
- Translate business and healthcare requirements into scalable technical solutions.
- Develop High-Level Design (HLD), Low-Level Design (LLD), architecture diagrams, sequence diagrams, integration designs, and Architecture Decision Records (ADRs).
- Define application, integration, data, security, and infrastructure architecture.
- Evaluate existing systems and recommend modernization, re-platforming, or re-engineering strategies.
- Establish architectural standards, design patterns, reusable components, and technology guidelines.
- Identify technical risks, dependencies, constraints, and opportunities for optimization.
- Ensure solutions meet functional and non-functional requirements.
- US Healthcare Domain Expertise
- Demonstrate strong end-to-end understanding of the US Healthcare ecosystem, including:
- Payer Systems
- Member enrollment and eligibility.
- Benefits and plan administration.
- Claims processing and adjudication.
- Provider management.
- Provider contracting.
- Prior authorization.
- Utilization management.
- Care management.
- Appeals and grievances.
- Risk adjustment.
- Medicare and Medicaid.
- Commercial healthcare insurance.
- Coordination of Benefits.
- Provider Systems
- Patient registration and demographics.
- Clinical workflows.
- EHR/EMR systems.
- Provider management.
- Appointment and encounter workflows.
- Clinical documentation.
- Laboratory and diagnostic integrations.
- Revenue cycle management.
- Provider billing.
- Claims
- Claims intake and validation.
- Claims adjudication.
- Claims pricing.
- Claims editing.
- Claims pend and exception handling.
- Claims payment and remittance.
- Claims denial and adjustment.
- Claims reconciliation.
- Provider reimbursement.
- Pharmacy / PBM
- Pharmacy claims.
- Formulary management.
- Drug benefits.
- Pharmacy networks.
- Prior authorization.
- Specialty pharmacy.
- PBM integrations.
- NCPDP and pharmacy-related workflows.
- Healthcare Interoperability & Integration
- Strong understanding of healthcare data exchange and interoperability standards is required.
- The candidate should have experience with:
- HL7
- FHIR
- X12 / EDI
- REST APIs
- SOAP Web Services
- JSON/XML
- API Gateways
- Healthcare integration platforms
- Event-driven integrations
- Batch and real-time integrations
- Strong knowledge of healthcare transactions such as:
- 270/271 – Eligibility Inquiry/Response
- 276/277 – Claim Status
- 278 – Healthcare Services Review
- 820 – Premium Payment
- 834 – Enrollment
- 835 – Healthcare Payment/Remittance
- 837 – Healthcare Claim
- 999 – Implementation Acknowledgment
- The candidate should understand how healthcare systems exchange information between payers, providers, clearinghouses, employers, government programs, PBMs, and other healthcare entities.
- .NET Architecture
- Strong expertise in the Microsoft technology ecosystem is required.
- Experience with:
- C#
- .NET Framework
- .NET Core / modern .NET
- ASP.NET Core
- Web API
- RESTful services
- Entity Framework / EF Core
- LINQ
- Dependency Injection
- Microservices
- Distributed applications
- SQL Server
- Azure services
- Authentication and Authorization
- The candidate should have experience designing enterprise-grade applications using appropriate architectural patterns, including Clean Architecture, Layered Architecture, Domain
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