Job description
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 facilitating the exchange of electronic data within HPSJ or between entities by designing, implementing, and maintaining EDI systems consistent with best practices and internal and external requirements. Work is varied and moderately complex and requires a moderate degree of discretion and independent judgment.
Supervises
- None.
Essential Functions
- Analyzes business requirements and creates EDI mapping specifications.
- Analyzes and interprets EDI data to identify trends, patterns, and issues.
- Monitors EDI transactions and troubleshooting errors.
- Creates and maintains detailed documentation for all reporting processes and procedures.
- Configures EDI software and mapping tools to translate data between different formats.
- Develops scripts and programs to automate EDI data processing.
- Ensures data security and compliance with EDI standards and regulations.
- Provides technical support and training to EDI users.
- Develops EDI integration strategies and roadmaps to meet business requirements.
- Analyzes and assesses EDI data requirements and mapping to internal systems.
- Configures and tests EDI systems, networks, and protocols to ensure effective data exchange.
- Collaborates with claims processing teams to improve data-driven decision-making.
- Stays current up to date with new technologies and tools in the data engineering field, and recommends and implements new tools as needed.
What You Bring:
Knowledge, Skills, Abilities and Competencies
Required
- Knowledge of and ability to effectively use EDI systems, software tools and processes.
- Strong knowledge of and ability to apply software development lifecycle and development methodologies.
- Strong knowledge of and skills in databases and data analysis.
- Strong knowledge of the data involved in healthcare transactions.
- Strong skills in SQL Query development, including but not limited to the ability to create moderately complex SQL queries with demonstrated experience in writing SQL scripts for data discovery, requirements validation, reports, and testing.
- Strong skills in programming languages such as Python, Java or C#.
- Strong knowledge of business and technical requirements documents with demonstrated with ability to capture user requirements and technical specifications using IEEE or similar standards.
- Strong knowledge of and ability to implement software/data testing best practices including unit, integration, and regression testing to deliver defect free solutions.
- Strong business acumen, with the ability to understand the operations and challenges in the various business units and how the organization’s information assets may be leveraged to provide solutions.
- Strong skills in dashboard development, including but not limited to the ability to create meaningful dashboards to customers’ satisfaction.
- Strong analytical skills with the ability to analyze and interpret large amounts of data, identify patterns and trends, and draw meaningful conclusions.
- Strong communication skills: The ability to communicate effectively with different stakeholders, including technical teams, business teams, and external partners.
- Ability to manage projects, track progress, and meet deadlines.
- Basic knowledge of relevant regulations and standards related to EDI, data privacy and data security.
- Ability to troubleshoot issues and find creative solutions to problems.
- Ability to work effectively in a team environment and collaborate with other departments to achieve common goals.
- 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.
- 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 ability to communicate complex technical issues to technical and non-technical audiences and write technical specifications.
- 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 listening skills, with the ability to accurately receive and understand messages.
- Intermediate skills in the Microsoft Office suite of products, with the ability to create large and complex documents, presentations, data/process flow diagrams, and complex spreadsheets, including formulas and pivot tables, for data analysis and presentation.
- Ability to speak and be understood in English.
- Ability to handle confidential information with appropriate discretion.
Preferred
- Experience with QNXT, or similar, claims payment system.
- Knowledge of and ability to apply data warehouse concepts.
- Knowledge of QNXT or other claims payments systems as they relate to EDI.
What You Have:
Education and Experience
Required
- Bachelor’s degree in computer science or business-related field; and
- At least five years of EDI experience in a healthcare environment, including experience with HIPAA requirements and X12; or
- Equivalent combination of education and experience.
Preferred
- Experience with QNXT, or similar, claims payment system.
- Experience using EDIFECS.
Licenses, Certifications
Required
- None.
What You Will Get:
HPSJ Perks:
- Competitive salary
- Robust and affordable health/dental/vision (90% paid medical for employees and 100% paid dental/vision for employees) 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.
Our Vision:
Continuously improve the health of our community.
Our Mission:
We provide healthcare value and advance wellness through community partnerships.
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.
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