Project Manager / Business Analyst - Healthcare Interoperability & Claims

United States — Remote, with moderate travel · Long-Term Contract | TAP Innovations, LLC

Client Engagement: Healthcare software platform for skilled nursing and senior living

Reports To: Client product and engineering leadership, with engagement oversight from TAP Innovations

About TAP Innovations

TAP Innovations is a technology consulting firm that designs, builds, and delivers cloud integrations, RPA, and custom software for enterprise clients. We help our customers eliminate the MESS — Manual Efforts and SpreadSheets — by connecting the systems they already run.

For this engagement, TAP is placing a senior delivery lead with a client building a modern, cloud-based platform for skilled nursing and senior living operators — covering the clinical record, healthcare data exchange, and the full medical billing cycle.

The Role

We're hiring a Project Manager / Business Analyst who can run delivery and write the requirements at the same time. You will own the plan, the backlog, and the stakeholder conversation for the platform's interoperability and claims capabilities, and you will be the person who turns payer rules, X12 transaction requirements, and Medicare and Medicaid billing policy into requirements an engineering team can build and test against.

This is not a generalist PM seat. The critical requirement is hands-on experience with medical claims processing — 837, 835, 276/277 and related X12 transactions — particularly in Medicare and Medicaid financials. You should be able to read a remittance, explain why a claim was denied, and know which link in the chain broke.

What You'll Work On

Project Management & Delivery

• Plan, run, and report on delivery of interoperability and claims features — scope, milestones, dependencies, risks, and release readiness
• Run sprint ceremonies and backlog grooming with a distributed engineering team, keeping priorities tied to business and revenue impact
• Coordinate external dependencies: clearinghouse onboarding, payer and EDI enrollment, trading partner testing, and certification timelines
• Own status reporting to client leadership — what is on track, what is at risk, and what decision is needed

Business Analysis & Requirements

• Perform current-state and gap analysis of billing, claims, and data-exchange workflows used by skilled nursing and senior living facilities
• Translate payer rules, companion guides, and program policy into clear functional requirements, user stories, and acceptance criteria
• Produce process maps, data mappings (field to loop, segment and element), and business rules for configurable payer and state logic
• Contribute to solution design with engineering — the claim status model, denial and rework queues, remittance posting, and A/R reporting
• Plan and run UAT with operational users; validate implementation against real-world scenarios before release

Medical Claims & Revenue Cycle

• Define requirements across the claim lifecycle: eligibility (270/271), authorization (278), claim submission (837I / 837P), acknowledgements (TA1, 999, 277CA), claim status (276/277), and remittance (835)
• Specify Medicare financial logic — Part A skilled stays, benefit periods, PDPM and HIPPS payment codes, consolidated billing, Part B, and Medicare Advantage
• Specify Medicaid financial logic — state-by-state variation, level-of-care authorization, patient liability, managed Medicaid, and retroactive rate changes
• Define coordination of benefits for dual-eligible residents, including crossover versus manual secondary billing
• Define denial management and A/R requirements — CARC/RARC analysis, rejection versus denial handling, timely filing, aging, and headline revenue cycle metrics

Interoperability & Health Information

• Gather and document requirements for Health Information Exchange (HIE) participation — query-based and directed exchange, patient matching, consent, and event notifications
• Apply Health Information Management (HIM) principles — legal medical record, amendments, release of information, retention, and audit — to product requirements
• Work with engineers on FHIR, HL7 v2 and C-CDA data flows, and on the code sets that join clinical and billing data (ICD-10-CM, CPT/HCPCS, revenue codes, NDC, LOINC)

What We're Looking For

Required

• Bachelor's degree — required.
• US-based and a native English speaker — required. This role works directly with US client leadership and US healthcare operators.
• 7+ years of combined project management and business analysis experience, with at least 5 years in healthcare
• Hands-on medical claims processing experience with X12 transactions — 837, 835, 276/277 — required. You have worked with these files and their acknowledgements, not only heard of them.
• Strong working knowledge of Medicare and Medicaid financials — required — including how each program pays, how coverage and benefit limits work, and how Medicare and Medicaid coordinate for dual-eligible patients
• Experience with healthcare interoperability — Health Information Exchange (HIE) and Health Information Management (HIM)
• Proven ability to write requirements engineers can build from: user stories, acceptance criteria, process flows, and data mappings
• Experience running delivery in an Agile environment with Jira, Azure DevOps, or equivalent
• Clear, confident communication with executives, clinicians, billing staff, and engineers
• Hands-on experience in or for skilled nursing, long-term care, post-acute or senior living facilities — required — including MDS 3.0, PDPM, UB-04 / institutional billing and Medicaid patient liability, on platforms such as PointClickCare or MatrixCare.
• Hands-on, daily use of AI tools in delivery work, including Claude (Cowork and Claude Design) — required. You can show examples of work you produced with them.
• Experience building process maps and diagrams in Miro or an equivalent tool
• Comfortable setting up and working independently across a managed laptop, Microsoft 365, Teams and cloud tools from day one

Strong Plus

• Clearinghouse experience — Availity, Waystar, Optum / Change Healthcare, or similar — including payer enrollment and trading partner testing
• Working knowledge of FHIR R4, HL7 v2, and C-CDA
• Exposure to state Medicaid MMIS systems, managed Medicaid, or Medicare Advantage authorization workflows
• Certifications such as PMP, CSM / PSM, CBAP, CRCR, CPB, RHIA or RHIT

How the Role Is Measured

• Delivery predictability — milestones hit, risks raised early, no surprises at release
• Requirements quality — stories accepted by engineering and QA without rework, and claim defects caught before release rather than after
• Claims outcomes of the features you deliver — acknowledgement and rejection visibility, clean claim rate, and denial reduction
• Stakeholder confidence — client leadership and operational users trust your status and your analysis

How You'll Work

Hands-on, not hands-off. You write the requirements yourself and you can walk an engineer through a remittance file line by line.

Distributed team. You will work with a US client leadership team and an engineering team that includes India-based engineers, with regular overlap during US business hours.

Documentation as a deliverable. Requirements, data mappings, and decisions live in the shared project tools, current and traceable.

Privacy first. You treat protected health information with care, and never place it in tickets, logs, screenshots, or sample files.

AI-assisted delivery. You use Claude day to day to draft requirements, analyse workflows and produce design artefacts.

Tools & Ecosystems You'll Work With

• Claims transactions: X12 837I / 837P, 835, 276 / 277, 277CA, 999, TA1, 270 / 271, 278
• Payers & programs: Medicare Part A / Part B, Medicare Advantage, state Medicaid and managed Medicaid
• Payment & billing: PDPM, HIPPS, consolidated billing, patient liability, coordination of benefits, CARC / RARC
• Interoperability: HIE, HIM, FHIR R4, HL7 v2 (ADT), C-CDA
• Code sets: ICD-10-CM, CPT / HCPCS, revenue codes, type of bill, NDC, RxNorm, LOINC, NPI
• Delivery tools: Jira or Azure DevOps, Confluence, Microsoft 365 / Teams, Claude (Cowork, Claude Design), Miro

Compensation

Competitive hourly contract rate, commensurate with experience. To be discussed during the interview process.

Engagement

This is a long-term engagement. It starts as a contract through TAP Innovations, and the client intends the relationship to be ongoing.

Location & Work Conditions

• Location: Remote, within the United States.
• Hours: US business hours, with regular overlap with an India-based engineering team.
• Employment type: Long-term contract, TAP Innovations, LLC.
• Work authorization: Must be authorized to work in the United States and reside in the US.
• Travel: Moderate travel required, to skilled nursing and senior living facilities with the product management team, to analyse features and gather requirements on site.