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Engineer II - EDI

Date: Aug 9, 2019

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 2950 

 

POSITION PURPOSE

 

The Engineer II – EDI is responsible is responsible for research and analysis of encounters and other EDI data and providing recommendations to team members in EDI team. These recommendations include, but not limited to providing guidance on analysis approach, rules development, workflow changes, communication protocols, data sources. The Engineer II – EDI must be able to work independently, often times working directly with business users and IT groups to understand and document requirements .

 

MAJOR RESPONSIBLITIES

 

  1. Comprehensive analysis of EDI underline data sources to determine the deficiencies for all LOBs.
  2. Provide recommendations for necessary changes in existing EDI processes.

  3. Monitor quality of data submitted to CMS and DHCS.

  4. Lead QA efforts for new or modified EDI processes.

  5. Guiding a team on topics related to encounters submissions to IEHP’s regulatory bodies, remediating submission errors.

  6. Establish and maintain effective working relationships with others throughout the organization.
  7. Incorporate LEAN principles into daily work.
  8. Any other duties as required to ensure Health Plan operations are successful.
  9. Ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP's policies and procedures relating to HIPAA compliance.

 

MINIMUM QUALIFICATIONS

 

Education/License:         

Bachelors degree from an accredited four year institution required, preferably with a major in Information Technology, Mathematics, Business Administration, or Healthcare.  Previous job experience will be considered in lieu of not having four year degree.  

 

Experience:     

4+ years in Healthcare EDI area. Experience with SQL programming.

 

Knowledge/Skills Required:    

Proficiency with Microsoft PC desktop applications including Excel, Word, Project, and Visio. Knowledge of IT SDLC Processes and QA  

practices. Excellent knowledge of Healthcare Industry knowledge.  In depth knowledge of Healthcare HIPAA requirements and CA State and   

CMS regulations and X12 formats required. Expertise in SQL, SSRS – required. Knowledge of BizTalk, EDIFECS or similar tools is a plus.  

A keen attention to detail. Excellent analytical and problem solving skills. Excellent organizational skills. Excellent written and  

oral communication skills. Excellent listening and interpersonal skills. Ability to effectively prioritize and execute tasks in a high-pressure 

environment. Strong customer service orientation. Experience working in a team-oriented, collaborative environment. A self-starter, able to work effectively with minimal direct supervision.

 

 

Starting Salary: $61,609  - $78,520  

Pay rate will commensurate with experience

 

Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 6,000 and a team of more than 2,000 employees, IEHP provides quality, accessible healthcare services to more than 1.2 million members. And our mission and core values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and Make a Difference with us! IEHP offers a Competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and retirement plan.

 


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles

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