Engineer III – EDI

Role Overview

• Find joy in serving others with IEHP!
• Responsible for analysis of new DHCS/CMS requirements and providing recommendations for new rules implementation, submissions tracking, remediating submission errors, responding to regulatory changes, and monitoring encounter submissions to DHCS and CMS, and acceptance compliance.
• Responsible for BRDs creation and communication with Trading Partners.
• Work independently, often working directly with business users and IT groups to understand and document requirements.
• Work cross-functionally with department leaders to deliver actionable analyses/results.
• Present findings of analyses to various staff levels.
• Provide recommendations for necessary changes in existing EDI processes.
• Monitor and Track quality and completeness of data submitted to CMS and DHCS.
• Analyze rejections and provide recommendations for remediation.
• Guiding team members on topics related to encounters submissions to IEHP’s regulatory bodies, remediating submission errors.
• Communicate with Trading Partners/ CMS/DHCS on needed basis
• Create BRDs
• Document and ensure assigned project/technical staff document all analysis/reporting projects following established protocols, ensuring replication of results by an independent reviewer.
• Demonstrate a commitment to incorporate LEAN principles into daily work.
• Establish and maintain effective working relationships with others throughout the organization.
• Ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP’s policies and procedures relating to HIPAA compliance.

Requirements

• Six (6) years of relevant work experience
• Bachelor's degree from an accredited institution required
• Master's degree in Data Science, Informatics, Public Health, Epidemiology, or a related field from an accredited institution preferred
• In depth knowledge of Healthcare HIPAA requirements and CA State and CMS regulations and X12 formats
• Expertise in SQL, SSRS.
• Knowledge of EDIFECS or similar tools is a plus
• Extensive knowledge of Microsoft Office (Excel, Word, Visio, and Power Point) is essential
• Working knowledge of medical terminology, knowledge of managed care, eligibility and/or pharmacy processes, and insurance terminology preferred
• Must be able to handle multiple projects, prioritize to meet deadlines, and develop effective working relationships
• Strong problem-solving capability, excellent interpersonal, and communication skills
• Ability to explain complex data analyses and findings in a way that is easy to understand and appropriate to the audience.
• Strong attention to detail

Tech Stack

• SQL

Benefits

• CalPERS retirement 457(b) option with a contribution match
• Generous paid time off
• vacation, holidays, sick
• State of the art fitness center on-site
• Medical Insurance with Dental and Vision
• Paid life insurance for employees with additional options
• Short-term, and long-term disability options
• Pet care insurance
• Flexible Spending Account – Health Care/Childcare
• Wellness programs that promote a healthy work-life balance
• Career advancement opportunities and professional development
• Competitive salary with annual merit increase
• Team bonus opportunities