Engineer III - EDI

IEHP; Rancho Cucamonga (CA); On-site; USD 118,601 - 157,144; Full time

Benefits offered by this job

CalPERS retirement

457(b) option with contribution match

Generous paid time off

State of the art fitness center on-site

Medical Insurance with Dental and Vision

Paid life insurance

Short-term and long-term disability options

Pet care insurance

Flexible Spending Account – Health Care/Childcare

Wellness programs

Career advancement opportunities

Competitive salary with annual merit increase

Team bonus opportunities

Job summary

IEHP in Rancho Cucamonga seeks an Engineer III focused on analyzing DHCS/CMS requirements and ensuring compliance with healthcare regulations. Responsibilities include creating BRDs and collaborating cross-functionally. A Bachelor's degree and 6 years of experience required, preferably with a Master's degree in a related field. The position offers a competitive annual salary ranging from $118,601.60 to $157,144.00, along with generous perks like medical insurance and paid time off.

Qualifications

• At least 6 years of relevant work experience.
• In-depth knowledge of HIPAA requirements and CMS regulations.
• Ability to explain complex data analyses clearly.

Responsibilities

• Analyze new DHCS/CMS requirements and provide recommendations.
• Create BRDs and communicate with Trading Partners.
• Monitor encounter submissions and compliance.

Skills

Healthcare HIPAA requirements

SQL

SSRS

Microsoft Excel

Microsoft Word

Microsoft Visio

Microsoft PowerPoint

Problem-solving capability

Interpersonal skills

Communication skills

Education

Bachelor's degree from an accredited institution

Master's degree in Data Science, Informatics, Public Health, or Epidemiology (preferred)

Tools

EDIFECS or similar tools

Job description

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!

Responsibilities

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.

Perks

• 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

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!

Pay Range: $118,601.60 USD Annually - $157,144.00 USD Annually