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Company: Community Health Group
Location: Chula Vista
Posted on: June 17, 2022

Job Description:

TITLE: EDI Programmer Analyst EEO1: Professional POSITION SUMMARY The EDI Programmer Analyst will work within a team of developers and analysts to plan, design, implement, and test EDI systems in support of Community Health Group's (CHG) core Medi-Cal and Medicare insurance programs. The position will facilitate the exchange of data with CHG's regulators, vendors, and provider network by implementing back-end processes to import and export data. All applications will be implemented within the Microsoft stack, particularly C# and Microsoft Sql Server. The EDI Programmer Analyst will work side by side with other EDI team members, and will be expected to participate in business analysis or quality assurance activities, as well as production tasks to support CHG's day-to-day operations. This position will proactively seek opportunities that will enhance CHG's revenue and reduce CHG's expenses while maintaining compliance with CHG's regulatory agencies. COMPLIANCE WITH REGULATIONS: This position works closely with all departments necessary to ensure that all processes, programs, and services are accomplished in a timely and efficient manner in accordance with CHG policies and procedures and in compliance with applicable state and federal regulations including CMS and/or Medicare Part D, DHCS, and Council for Affordable Quality Healthcare Committee on Operating Rules for Information Exchange (CAQH CORE). RESPONSIBILITIES Develop and Maintain EDI processes to import, transform, and export data to support business objectives. Develop scheduled tasks, power shell scripts, C# applications and SSIS packages to automate data imports. Build database repositories to store incoming data. Configure and debug BizTalk orchestrations to transform data and store it within our core repositories. Configure other EDI components for healthcare related transactions including: QNXT, TIBCO, MoveIT, and SFTP servers. Analyze business processes and functions, and interpret regulatory requirements to guide the development of new EDI interfaces with CHG's trading partners and core business systems. Gather, analyze, and document requirements from business users, regulators, and healthcare partners. Research and evaluate file specifications, including ANSI x12 EDI transactions, HL7 specifications, National Council for Prescription Drug Programs (NCPDP) specifications, and custom specifications created by vendors and state\federal regulators. Serve as a subject matter expert in new EDI data regulations and quality measurements. Attend and participate in encounter data, program data, and provider data workgroups and webinars. Audit data supplied by providers and trading partners for accuracy. Test new system integrations to ensure compliance with documented requirements. Provide support for provider inquiries and issues related to EDI enrollment, claims processing, payment inquiries, and clearinghouse activities, with duties including but not limited to: Resolve issues related to production EDI transactions related to claims, payments, enrollment, provider data, real time transactions, clearinghouse activities and other proprietary EDI formats. Monitor EDI exchanges and transaction processes to ensure they run efficiently and correctly. Work with external providers and regulators to research and reconcile EDI transactional inquiries, errors, and discrepancies. Identify errors and escalate complex issues to higher levels for assistance and review. Monitor the submission of encounter data from subcontractors to ensure completeness, accuracy, reasonability, and timeliness prior to submission to state and federal agencies. Maintain desktop procedures, companion guides, and other supporting documentation for all critical EDI processes. Develop and maintain documentation of EDI requirements and specifications. Support cost benefit analysis, impact analysis and assessments for strategic operational projects and policy and operational changes. Maintain documents for operational procedures according to HIPAA standards and regulatory guidelines. Education: Bachelor's Degree in Computer Science, Computer Engineering, or Information Systems. Experience/Skills: Minimum of 3 years experience working software development or business analysis. Good communication skills, and experience working with teams. Experience developing web and windows based services in C#. SQL Server, including T-SQL stored procedures, and Integration Services (SSIS). Familiarity with XML and JSON document formats. Working knowledge of the software development lifecycle. Working knowledge of research, analysis, and reporting methods. Familiarity with testing procedures, including unit testing and regression testing, as well as test plan development and documentation of test results. Adherence to security requirements and confidentiality as required by the company and HIPAA. Ability to demonstrate flexibility and creativity, identify improvements to existing practices, and effectively adapt to change Expertise in the following areas is not required but preferred: CAQH CORE Operating Rules QNXT Core Administrative Payer System Knowledge of the followings specifications or transaction sets: X12 EDI HIPAA transaction sets: 820, 834, 274, 270/271, 276/277, 277CA, 835, 837 P/I, 999 HL7 FHIR DHCS pharmacy encounter data NCPDP File Medical billing and health care data interfaces Medi-Cal and Medicare programs Physical Requirements: May be required to work evenings and/or weekends. The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. Community Health Group is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment based on any protected characteristic as outlined by federal, state, or local laws. This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, and trainings. Community Health Group makes hiring decisions based solely on qualifications, merit, and business needs at the time. For more information, see Personnel Policy 3101 Equal Employment Opportunity/Affirmative Action. Employment Type: Full Time Years Experience: 3 - 5 years Bonus/Commission: No

Keywords: Community Health Group, Chula Vista , Programmer, IT / Software / Systems , Chula Vista, California

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