Engineer III - EDI

Overview What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Under the direction of the Encounters & EDI Leadership Team, the Engineer III is responsible for analysis of new DHCS/CMS requirements and providing recommendations for new rules implementation, submissions tracking, remediating submission errors, responding to regulatory changes, and monitoring encounter submissions to DHCS and CMS, and acceptance compliance. The Engineer III also is responsible for BRDs creation and communication with Trading Partners. The Engineer III must be able to work independently, often working directly with business users and IT groups to understand and document requirements. The Engineer III will work cross-functionally with department leaders to deliver actionable analyses / results. Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Additional Benefits Perks IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more. CalPERS retirement 457(b) option with a contribution match Generous paid time off- vacation, holidays, sick State of the art fitness center on-site Medical Insurance with Dental and Vision Paid life insurance for employees with additional options Short-term, and long-term disability options Pet care insurance Flexible Spending Account – Health Care/Childcare Wellness programs that promote a healthy work-life balance Career advancement opportunities and professional development Competitive salary with annual merit increase Team bonus opportunities Key Responsibilities Present findings of analyses to various staff levels. Present results in formats that are easy to understand and appropriate to the audience. Provide recommendations for necessary changes in existing EDI processes. Monitor and Track quality and completeness of data submitted to CMS and DHCS. Analyze rejections and provide recommendations for remediation. Guiding team members on topics related to encounters submissions to IEHP’s regulatory bodies, remediating submission errors. Communicate with Trading Partners/ CMS/DHCS on needed basis Create BRDs Clear understanding of IEHP business operations Responsible for managing assigned projects and effectively communicating project team to ensure project deliverables and deadlines are met. Document and ensure assigned project / technical staff document all analysis / reporting projects following established protocols, ensuring replication of results by an independent reviewer. Demonstrate a commitment to incorporate LEAN principles into daily work. Establish and maintain effective working relationships with others throughout the organization. Any other duties as required to ensure the Health Plan 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. Qualifications Education & Experience Six (6) years of relevant work experience Bachelor's degree from an accredited institution required Master's degree in Data Science, Informatics, Public Health, Epidemiology, or a related field from an accredited institution preferred Key Qualifications In depth knowledge of Healthcare HIPAA requirements and CA State and CMS regulations and X12 formats Expertise in SQL, SSRS. Knowledge of EDIFECS or similar tools is a plus Extensive knowledge of Microsoft Office (Excel, Word, Visio, and Power Point) is essential Working knowledge of medical terminology, knowledge of managed care, eligibility and/or pharmacy processes, and insurance terminology preferred Must be able to handle multiple projects, prioritize to meet deadlines, and develop effective working relationships Strong problem-solving capability, excellent interpersonal, and communication skills Ability to explain complex data analyses and findings in a way that is easy to understand and appropriate to the audience. Strong attention to detail Start your journey towards a thriving future with IEHP and apply TODAY! Work Model Location This position is on a hybrid work schedule. (Monday & Friday - remote, Tuesday – Thursday onsite in Rancho Cucamonga, CA.) Position is eligible for Hybrid work location upon completing the necessary steps and receiving HR approval. All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership. Pay Range USD $118,601.60 - USD $157,144.00 /Yr. #J-18808-Ljbffr Inland-Empire-Health-Plan-