The IT Specialist II will work with the client implementation team to assist in the on boarding of new clients. The IT Specialist II will be responsible in evaluating the X12 transactions (999, 277CA and MAO’s – 837) as well as CSV formats. The IT Specialist II will also manage file transmissions and continuously strive to improve the department processes and procedures and ensure efficient workflows within the Operation -IT. They will be responsible for any testing that occurs during new client implementations and client transitions to other eligibility methods. The IT Specialist II will also be a key component in the claim generation process and creation of data to create an X12 837 file for claim submission.
The position will participate in design and development of client/server systems which utilize pre-defined file formats for all vendors, in addition to SQL Server-based reporting and assist database security.
Excellent verbal and written communication skills.
Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers.
Ability to meet deadlines and work within a deadline driven department.
Analyze, design, develop, test, troubleshoot, enhance and maintain EDI transaction sets in various formats that include 837, TA1, 999, 277CA and MAO’s and EVR’s as well as HTML formats.
Maintain detailed documentation and process flow of all EDI processes.
Evaluate client requests for new EDI features and give suggestions to direct manager.
Participate in project meetings providing input to project plans and providing status updates as required.
At the request of end users or management, research questions involving EDI applications and how the data is organized and populated.
Provide status updates on all assigned tasks.
Manage and ensure quality and consistent delivery for EDI Encounter transactions (837)
Ensure correct mapping to response data (837, 999, 277CA and MAO’s) to any 837 submissions.
MS SQL Server 2012, SSIS, SSRS, SSAS and Data warehousing/data modeling concepts preferred.
Test with Trading Partners for compliance within regulatory and environmental changes as they relate to ANSI transactions.
Use Quality Assurance measures to troubleshoot and resolve issues related to all aspects of file data loading and processing.
Any other duties as required to ensure the Health Plan EDI operations are successful.
Ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP's policies and procedures relating to HIPAA compliance.
High School diploma or equivalent requierd. Bachelors degree preferred.
The following experience may be concurrent, preferably in a health care setting: Two (2) years in data extraction, transformation, and loading (ETL) One (1) year in database administration and development, using Microsoft SQL Server or similar relational database application. One year programming with Structured Query Language (SQL).
Techniques of relational database analysis, design, and implementation, including data mining and transformation techniques, principles and practices of project control, physical and logical security techniques, experience with Microsoft SQL Server, and client/server principles and techniques. Demonstrated strong analytical skills. Excellent customer service with both internal and external customers. Ability to read and process ANSI X12 files formats.
Pay Range: $49,192 - $75,441
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.