EDI Developer, Specialist

The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. What You Will Be Doing: Under general supervision, responsible for managing complex/custom data processing, creating advanced procedures and systems, providing detailed technical analytics for complex automated process improvement projects, designing logical workflow applications, and managing the core system for the company. EDI Developer, Specialist elicits highly complex/custom business requirements through group meetings, interviews, observation, and/or existing systems, and business or policy documentation. This role independently mentors and contributes to the EDI team with complex and comprehensive documentation of the technical requirements or systems modifications in a format that facilitates business and technical communication and understanding amongst the business department or individuals. The EDI Developer, Specialist must have the ability to independently analyze or mine data, draw sound conclusions, and is able to interpret and follow detailed and precise written and oral instructions such as checklists, process diagrams, and policy. The EDI Developer Specialist will lead communications and facilitation efforts to present the documented findings and results from an analytical engagement. The position will be required to lead, work with, and mentor people of various professional, vocational, and educational backgrounds. Remote. Must reside in California Our Vision: Continuously improve the health of our community. Our Mission: We provide healthcare value and advance wellness through community partnerships. Essential Functions: Works with Executives, Management, Staff, or Business analysts to identify, document, and redesign complex business concepts or processing conflicts. Provides formal user education with software productivity and technical tools such as SSRS, SSIS, SharePoint, Microsoft Office, Visio, Team Foundation Server, or automation tools to document business and technical process requirements related to a technology system. Comprehends, analyzes, and documents business or process requirements using personal interviews, document analysis, meetings, surveys, process documents, or actual scenarios. Analyzes and documents functional business environments that facilitate work throughout the company. Develops complex business requirements and specifications through internal and external research to complete technical analysis, and articulate and formally present research to various skill levels. Leads business meetings leveraging the Agile process to assist business units in the "What" session to ensure the creation and documentation of stories and acceptance criteria. Provides and may lead technical interpretation to other technical teams in the Agile "How" session to understand technical requirements related to the business stories and acceptance criteria. Effectively communicates and collaborates with internal and external customers in support of analytics or problem resolution. Recommends reconciliation points necessary after a comprehensive process or data analytics engagement to mitigate/resolve present and future reconciliation conflicts. Comprehends and implements system configuration changes of the managed care core system software to process data transactions for business functions such as eligibility, claims, authorizations, and case management. Mentors and leads in the creation of testing plans that are used in the testing and implementation of software systems used by the organization. Oversees, identifies, and creates process checklists, for self and other analysts, which will be used to process Health Plan of San Joaquin (HPSJ) programs and applications to support departmental activities. May assume the duties of a Project Manager for medium to large-sized projects using standard PMBOK processes to identify scope, requirements, resources, and stakeholders using standard analysis techniques. Leads and mentors in technical areas and independently provide knowledge and documentation exchange to educate team members in Analytical roles in support of team redundancy. What You Bring: Knowledge, Skills, Abilities and Competencies Required Expert knowledge of and ability to apply the American National Standards Institute (ANSI) formats that govern healthcare Electronic Data Interchange (EDI). Must have at least four (4) years of experience developing and maintaining Healthcare EDI X12N transactions, including batch and real-time formats such as: 837I/837P, 274, 834, 835, 270/271. Requires at least four (4) years of Edifecs hands-on experience with Healthcare EDI X12N transactions, including analytics, mapping, developing, testing, and deployment. Demonstrates a working knowledge of Edifecs: Architecture, SpecBuilder, Enterprise Application Manager, and Transaction Management, including Trading Partner Manager, and deployment procedures. Expert knowledge of HL-7 and NCPDP File Formats, QNXT Healthcare Core Systems, including knowledge of QNXT EDI Manager and QNXT Connect (MS BizTalk). Advanced knowledge of and ability to apply SDLC (Software Development Life Cycle) and Agile Scrum Methodologies. Ability to independently create technical processing to promote automation to perform repetitive or analytical tasks within productivity software. Ability to formulate and maintain structure query language (SQL) queries for analytical data mining, software development, TFS, Stored Procedures, ETL, and business reporting and comprehend various programming languages. Possesses a keen attention to detail and performs excellent analytical and problem-solving skills. Has limited skills in the capacity of other departmental technologies, resources, and roles in order to provide detailed analytics in everyday communications. In-depth knowledge and understanding of medical terminology to include ICD, CPT, and HCPCS coding systems related to encounters and 837s. Must convey outstanding listening and interpersonal skills and have the ability to effectively prioritize and execute tasks in a high-pressure environment and support strong customer service orientation. Must exhibit mastery experience in a team-oriented, collaborative environment as a self-starter with ability to work effectively with minimal direct supervision. Interpersonal skills - interacts effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people. Strong oral and written communication skills, with the ability to effectively communicate complex technical issues in terms clearly understood by technical and non- technical audiences and write technical specifications. Exemplifies excellent organizational, written, and verbal communication skills and the ability to interact professionally with a diverse group, executives, managers, and subject matter experts. Strong listening skills, with the ability to accurately receive and understand messages. Strong problem solving and analytical skills, with ability to determine key issues, develop effective action plans and implement successful conclusions. Produces work that is accurate and complete. Produces the appropriate amount of work. Actively learns through experimentation when tackling new problems, using both successes and failures to learn. Rebounds from setbacks and adversity when facing difficult situations. Knows the most effective and efficient process to get things done, with a focus on continuous improvement. Demonstrates a commitment to HPSJ's strategy, vision, mission, and values. Time management and organizational skills. Uses time effectively and efficiently. Values time. Concentrates his/her efforts on the more important priorities. Can attend to a broader range of activities. Meets deadlines. Strong skills in Windows, Excel, Word, Outlook, and Visio. Ability to work independently and as part of a team. Ability to speak and be understood in English. Ability to handle confidential information with appropriate discretion. What You Have: Education and Experience Required Bachelor's degree in computer science, Mathematics, or related field; and At least eight years progressive experience in an EDI role or similar analytical position for a medium to large organization with a structured IT department; or At least 12 years of progressive experience in an EDI Analyst capacity or similar analytical position for a medium to large organization with a structured IT department. Preferred Experience in healthcare. Experience with Tableau. Licenses, Certifications None required. What You Will Get: HPSJ Perks: Competitive salary Robust and affordable health/dental/vision with choices in providers Generous paid time off (starting at 3 weeks of PTO, 4 paid floating holidays including employee's birthday, and 9 paid holidays) CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan Two flexible spending accounts (FSAs) Employer-Paid Term Life and AD&D Insurance Employer-Paid Disability Insurance Employer-Paid Life Assistance Program Health Advocacy Supplemental medical, legal, identity theft protection Access to exclusive discount mall Education and training reimbursement in addition to employer-paid elective learning courses. A chance to work for an organization that is mission-driven - our members and community are at the core of everything we do. A shorter commute - if you're commuting from the Central Valley to the Bay Area. Visibility and variety - you have a chance to work with people at all levels of the organization, and work on diverse projects. We are an equal opportunity employer and diversity is one of our core values. We believe that differences including race, ethnicity, gender, sexual orientation, and other characteristics, will help us create a strong organization that is sensitive to the needs of those we serve. Employment decisions are made on the basis of qualifications and merit. HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation or any other characteristic made unlawful by applicable Federal, State or local laws. It also prohibits unlawful discrimination based on the perception that anyone has these characteristics or is associated with anyone who has or is perceived to have these characteristics. Important Notice: This job description is not a contract between HPSJ and the employee performing the job. The duties listed in the job description may be changed at the discretion of HPSJ, and HPSJ may request the employee to perform duties that are not listed on the job description.