Healthcare Solutions Consultant – NPHIES Compliance

3 days ago

Karachi, Sindh, Pakistan iTack Solutions Full time 900,000 - 1,200,000 per year

The NPHIES Consultant will be responsible for ensuring full compliance, integration, and optimization of healthcare systems with the
NPHIES (National Platform for Health and Insurance Exchange Services)
standards. This role involves validating test cases, managing end-to-end integration scenarios, supporting internal and external teams in understanding the NPHIES ecosystem, and leading RCM (Revenue Cycle Management) readiness for live deployment.

Responsibilities:

  • Execute and validate NPHIES compliance test cases across all transaction types — Eligibility, Authorization, Claim, and Payment.
  • Ensure FHIR-based data conformity and accurate mapping of resources and SBS codes.
  • Design and test end-to-end NPHIES workflows, simulating real healthcare and financial scenarios.
  • Coordinate with development and QA teams to ensure seamless integration and data exchange.
  • Conduct internal workshops and training sessions to enhance team understanding of the NPHIES ecosystem.
  • Participate in official NPHIES testing and certification sessions, demonstrating system readiness and addressing reviewer feedback.
  • Review and validate Revenue Cycle Management (RCM) processes for full NPHIES compliance.
  • Prepare and maintain documentation, including test reports, workflow diagrams, and compliance checklists.
  • Identify gaps, rejections, or integration issues, and collaborate with teams to resolve them.
  • Provide go-live readiness support, including risk identification, fallback strategies, and performance tracking.
  • Recommend process improvements and automation to enhance NPHIES transaction success rates.

Requirements:

  • Strong understanding of
    NPHIES data standards
    ,
    CCHI rules
    , and
    Saudi healthcare ecosystem
    .
  • Familiarity with
    FHIR
    ,
    HL7
    ,
    JSON/XML
    , and
    API-based integrations
    .
  • Excellent analytical and problem-solving abilities.
  • Effective communication and coordination with technical, QA, and business teams.
  • Strong documentation and presentation skills.

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