Solutions Architect, Principal

Company Overview

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem‑solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Job Summary and Responsibilities

Acentra Health is looking for a Solutions Architect, Principal to join our growing team.

We are seeking a highly experienced Principal Solution Architect with deep expertise in the Healthcare Claims domain to drive product evolution within our Product Engineering team. This role is strongly domain‑led, focusing on claims, Third Party Liability (TPL), and Prior Authorization (PA), ensuring solutions align with complex payer operations, regulatory requirements, and multi‑state program needs.

The ideal candidate is a domain‑first leader who can translate intricate healthcare processing requirements into scalable, configurable product capabilities while partnering closely with Product Management, Business, Engineering, and Implementation teams.

Responsibilities

• Claims, TPL & Prior Authorization Domain Leadership
  • Serve as a subject matter expert across Claims, TPL, and Prior Authorization domains.
  • Own the end‑to‑end claims lifecycle: intake, validation, adjudication, pricing, edits, payment, and coordination of benefits (COB).
  • Drive TPL capabilities including third‑party identification, cost avoidance, recovery, and COB processing.
  • Lead Prior Authorization workflows including intake, clinical rule evaluation, approvals/denials, and downstream claims integration.
  • Interpret and translate Medicaid/Medicare, CMS, and state‑specific requirements into scalable product features.
  • Ensure alignment with industry‑standard code sets (CPT, HCPCS, ICD‑10, DRG, NDC, revenue codes).
  • Define business rules, configurations, and processing logic to support real‑world payer operations.
  • Identify functional gaps and drive continuous product enhancements and innovation.
• Product Strategy & Functional Ownership
  • Partner with Product Management to define domain‑driven roadmaps and priorities.
  • Own functional solutioning for new capabilities, enhancements, and modernization efforts.
  • Ensure solutions are configurable, reusable, and scalable across programs and states.
  • Lead requirement definition, backlog refinement, and prioritization with clear business outcomes.
• Regulatory & Compliance Alignment
  • Ensure compliance with HIPAA, X12 (837/835/276/277), CMS guidelines, and state mandates.
  • Embed auditability, traceability, and compliance controls into product capabilities.
  • Continuously assess impact of regulatory changes on product features.
• Integration & Ecosystem Alignment
  • Define functional integrations with EDI systems, pricing engines, enrollment/eligibility systems, and external vendors.
  • Support data exchange strategies across claims ingestion, adjudication, and downstream systems.
  • Ensure interoperability across Claims, TPL, and PA modules.
• Delivery Ownership & Execution
  • Act as a bridge between business intent and engineering execution.
  • Own and manage product backlog (epics, features, user stories) with clear acceptance criteria.
  • Ensure requirements are well‑defined, testable, and aligned with expected outcomes.
  • Participate in design reviews, solution discussions, and defect triage.
  • Validate claims scenarios, pricing logic, and adjudication outcomes during testing.
  • Make informed trade‑off decisions balancing scope, quality, and timelines.
• Stakeholder Engagement
  • Act as a primary liaison across business, product, engineering, QA, UX, and implementation teams.
  • Lead workshops, working sessions, and design discussions.
  • Provide clear communication, risk visibility, and executive updates.
• Governance, Quality & Release Management
  • Ensure delivered solutions meet functional expectations, quality standards, and business outcomes.
  • Support UAT, test validation, and production readiness.
  • Review and approve release notes, documentation, and training materials.
  • Guide stakeholders through product changes and feature rollouts.
• Leadership & Mentorship
  • Act as a trusted advisor and domain leader across the organization.
  • Mentor teams on claims processing, TPL, PA workflows, and industry standards.
  • Drive cross‑functional alignment and shared understanding of domain workflows.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

Qualifications

Required Qualifications

• Bachelor's or Master's degree or equivalent combination of experience in lieu of a degree.
• 12+ years of experience with strong focus on Healthcare Claims systems.
• Deep expertise in claims adjudication, pricing, payment processing, and COB.
• Strong knowledge of TPL and Prior Authorization processes.
• Experience with Medicaid/Medicare programs and payer operations.
• Hands‑on experience with EDI transactions (837, 276, 277, 835).
• Proven ability to translate complex business needs into functional solutions and structured requirements.
• Experience delivering enterprise‑scale product platforms.

Preferred Qualification

• Experience with state Medicaid implementations or multi‑state platforms.
• Familiarity with Pricing as a Service (PaaS) and configurable claims engines.
• Exposure to Enrollment, Eligibility, and Provider management systems.
• Understanding of modern product engineering and cloud‑based platforms.

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Pay Range

USD $157,600.00 - $197,000.00 /Yr.

EEO Statement

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

EEO AA M/F/Vet/Disability

Other Information

Experience in Lieu of Degree: For non‑clinical roles, or when not required by the contract specifically, the Company acknowledges that practical, hands‑on experience can provide skills and competencies equivalent to formal education. As such, in cases where a Bachelor's degree may be required, the Company will accept a minimum of six (6) years of directly relevant professional experience in lieu of a degree. In instances where the candidate has an Associate's degree, the Company will accept a minimum of three (3) years of directly relevant professional experience in lieu of the Bachelor's degree.

Compensation: The pay for this position is listed below. Based on our compensation philosophy, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.

Thank You! We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

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