Senior Sales Solutions Consultant

About this role

Overview
The Sr Sales Solution Consultant – Healthcare is a client-facing presales professional who helps healthcare payer organizations modernize and optimize data exchange across administrative and clinical workflows. The role combines practical expertise in healthcare EDI/X12 and FHIR-based interoperability with consultative discovery, solution design, presentations, demonstrations, and technical validation.
The consultant partners with Sales, Product, Engineering, Delivery, and client stakeholders to translate payer business and regulatory requirements into feasible interoperability solutions and clear business value.
Responsibilities
Healthcare Interoperability and Domain Expertise

• Serve as a subject matter resource for payer interoperability use cases spanning claims, encounters, enrollment, eligibility, prior authorization, remittance, provider data, and member data exchange.

• Apply working knowledge of HIPAA EDI/X12 transactions, including 270/271, 276/277, 278, 834, 835, 837, 999 and TA1 acknowledgements, as relevant to client workflows.

• Apply working knowledge of FHIR and payer-provider exchange patterns.

• Explain how EDI and FHIR coexist in payer environments, including translation, orchestration, validation, routing, exception handling, acknowledgements, and operational monitoring.

• Stay current on CMS interoperability and prior authorization requirements and related industry implementation guidance.

Discovery, Solutioning, and Architecture

• Lead or support technical discovery sessions to understand the client’s current-state systems, trading-partner landscape, transaction volumes, data quality, workflows, pain points, and desired outcomes.

• Document current- and future-state data flows, integration points, interfaces, assumptions, dependencies, risks, and non-functional requirements.

• Develop solution approaches that may include EDI gateways, FHIR server, mapping and validation services, workflow orchestration, identity and access controls, monitoring, and analytics.

• Whiteboard solution architectures and communicate tradeoffs clearly to business, operational, and technical stakeholders.

• Partner with Product, Engineering, Security, and Delivery teams to validate feasibility and avoid unsupported commitments.

Presales and Client Engagement

• Partner with account executives through qualified sales pursuits, from discovery and solution strategy through technical validation and handoff.

• Develop and deliver tailored presentations, demonstrations, workshops, and solution narratives that connect interoperability capabilities to business, compliance, administrative-efficiency, and provider-experience outcomes.

• Contribute substantive technical and functional content to RFP/RFI responses and proposals; this role is not primarily an administrative proposal-coordination position.

• Support proofs of concept or pilots when they are appropriate to validate solution fit and reduce client decision risk.

• Respond credibly to questions, objections, competitive concerns, and requests for clarification while documenting follow-up actions.

Cross-Functional Collaboration and Practice Development

• Capture market and client feedback for Product and Technology teams and identify recurring interoperability requirements or capability gaps.

• Create reusable discovery questions, architecture patterns, presentation content, demonstration scenarios, and technical reference material.

• Maintain accurate opportunity documentation and support a disciplined transition from presales to delivery.

• Complete all responsibilities as outlined in the annual performance review and/or goal setting.

• Complete all special projects and other duties as assigned.

• Must be able to perform duties with or without reasonable accommodation.

This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change.
Qualifications

• Bachelor’s or Associate degree in computer science, information technology, engineering, healthcare, business, or a related field, or equivalent relevant experience.

• 5+ years of experience in healthcare technology, interoperability, solution consulting, sales engineering, implementation consulting, or a comparable client-facing technical role.

• Meaningful experience in the healthcare payer ecosystem and familiarity with claims, encounters, enrollment, eligibility, prior authorization, remittance, provider, or member workflows.

• Hands-on knowledge of healthcare EDI/X12 transactions and associated validation, mapping, acknowledgements, routing, and exception-management concepts.

• Ability to translate complex technical concepts into clear business value for both technical and non-technical stakeholders

• Excellent communication, presentation, and whiteboarding skills, with experience engaging senior client stakeholders

• Experience working effectively across cross-functional teams (sales, product, engineering, delivery) and manage multiple concurrent priorities

• Willingness to travel as required for client-facing engagements

Preferred Qualifications

• Experience with payer interoperability platforms, EDI gateways, API management, FHIR servers, integration engines, or comparable healthcare data-exchange technologies.

• Familiarity with CMS interoperability and prior authorization rules and FHIR implementation guides such as Da Vinci CRD, DTR, and PAS.

• Experience with end-to-end solution architecture, including integration patterns, ETL processes, and cloud-based data platforms

• Familiarity with regulatory requirements (e.g., CMS mandates, interoperability and prior authorization rules)

Cognitive and Mental Requirements

• Ability to analyze complex information and…