Title Consulting Practice Leader Healthcare Provider Data SME
Location Remote-NJ/NY/PA, Boston, Philadelphia, or SF Bay Area, CA preferred
Key Responsibilities
1. Enterprise Data Product & Domain Strategy
- Lead the definition, development, and governance of core Provider Data Products (e.g., Provider 360, Master Provider Index/EMPI, Practitioner Directory, Provider Network & Alignment, Provider Roster Management).
- Define domain-specific data architectures and data lifecycle strategies across clinical, administrative, credentialing, and billing domains.
- Establish data product ownership models, domain definitions, and lifecycle management frameworks for provider-centric data assets.
2. Subject Area & Industry Data Modeling
- Architect and refine Provider Subject Area Data Models across key domains: Provider Master Data, Credentialing & Privileging, Network/Payer Contracts, Scheduling/Availability, Provider Attribution, and Clinical Performance.
- Guide the adoption and customization of standard industry data models and frameworks (e.g., HL7 FHIR Practitioner/PractitionerRole resources, OMOP CDM, CAQH standards, and vendor enterprise models such as Epic Clarity/Caboodle provider schemas or Cerner CCL).
- Standardize reference data, taxonomy mappings, and code sets across the health system (e.g., NPI, NUCC Provider Taxonomy, State License IDs, CAQH, Provider Specialty Groups).
3. Client Advisory & Cross-Functional Alignment
- Serve as the trusted advisor to hospital system executives (CDO, CIO, Chief Medical Officer, VP of Revenue Cycle) on provider data strategy and data quality initiatives.
- Drive cross-departmental alignment between Provider Enrollment, Medical Staff Services, Clinical Operations, IT/Data Engineering, and Managed Care Contracting.
- Establish and facilitate data governance bodies specific to Provider Data Quality, Stewardship, and Integration.
4. Data Governance, Quality & Stewardship
- Implement data quality frameworks, stewardship workflows, and automated validation pipelines tailored to complex provider entities (individual vs. organizational providers, affiliations, locations, and panel capacities).
- Establish MDM (Master Data Management) and Identity Resolution protocols to solve multi-source provider duplicate, merge, and alignment issues across disparate systems.
Required Skills & Expertise
Healthcare Provider Data Knowledge
- Provider Data Sub-Domains: Deep expertise in Provider Master Data (MDM), Practitioner vs. Organizational Provider distinction, Medical Staff Credentialing/Privileging, Provider Attribution, Panel Management, and Provider-Location-Specialty relationships.
- Standard Industry Models & Protocols: In-depth knowledge of HL7 FHIR (Practitioner, Practitioner Role, Healthcare Service, Location resources), CAQH, NUCC Taxonomy, and relational/analytical dimensional modeling for healthcare.
- Health System Source Systems: Hands-on familiarity with EHR data models (Epic Clarity/Caboodle, Cerner), Credentialing systems (e.g., Echo, Cactus, Symplr), and Provider Directory / MDM solutions (e.g., Informatica, Reltio, IBM MDM).
- Reference Data & Identifiers: Master-level understanding of NPI (NPPES), DEA, State Licensing, Medicare/Medicaid Enrollment (PECOS), taxonomy codes, and taxonomy crosswalks.
Consulting & Leadership Skills
- Advisory Leadership: Proven experience leading long-term data transformation engagements within large integrated delivery networks (IDNs) or academic medical centers.
- Data Product Management: Ability to manage data assets as products-defining roadmap, user stories, schema specifications, and business value metrics.
- Stakeholder Facilitation: Strong track record of aligning technical teams (ETL, Data Warehousing, Cloud Data Engineers) with business/clinical stakeholders.
Qualifications
- Experience: 8+ years in healthcare data domain consulting or enterprise health system informatics, with a focus on provider data architecture, data governance, and data warehousing.
- Education: Bachelor's or master's degree in health informatics, Computer Science, Information Systems, or a related quantitative field.
- Certifications (Preferred): FHIR Certification, Certified Health Data Analyst (CHDA), or Enterprise Data Governance certifications (e.g., CDMP).
Education
- Bachelors or Master's degree in Computer Science, Information Technology or relevant field