Engineer III - EDI
Inland Empire Health Plans
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Benefits offered by this job
Job summary
Qualifications
- 6 years of relevant work experience required.
- Bachelor's degree from an accredited institution required.
- Master's degree preferred in related fields.
Responsibilities
- Analyze new DHCS/CMS requirements and provide recommendations.
- Track submissions and remediate errors.
- Work cross-functionally with department leaders.
Skills
Education
Tools
Job description
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.
- 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
- 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
- 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
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