Develop and Support a paperless (electronic) system for conducting business
Manage inbound data feeds including: all claim file types, MOR, MMR, DXHCC, RAPS, Reconciliation files, eligibility and capitation data
Manage outbound encounter data submission and process, Alternate Submission Methods (ASM), and supplemental "Clinical data submissions to health plan trading partners or designated clearinghouses
Responsible for full reconciliation of encounter data between clients, Health plans and CMS
Responsible for analysis of Care gap reports and to identify data gaps
Support the centralization of information for using OnBase for content management
Support claims in load processes and procedures
Lead all Encounter and EDI related projects
Attend various meeting including: Operations, project specific, JOCs / encounter performance and adhoc
Communicate business needs, requirements and enhancement ideas
Report issues and failures
Confirm audit and/or exception reports are run at appropriate frequencies and identified items and exceptions are resolved satisfactorily and within expected timeframes
Work with team to enhance operations, comply with new regulations, resolve failures and document policies and procedures
Required Skills and Abilities
Bachelor's Degree (four-year college or technical school) Required, Field of Study: Computer Science, Information Systems or equivalent experience
3+ years of experience in Software Development
Thorough knowledge of programming languages including VB, C#, SQL, PowerShell
3+ years of SQL Server ETL Development experience using SSIS
3+ years of experience with Microsoft SQL Reporting Services (SSRS)
Proficient in using Team Foundation Server for source control
Experience with SQL Server 2012
Experience with Transactional Systems, specifically X12 Claims, Eligibility and Authorization transactions
EZCAP and EZEDI experience preferred
Experience with encounter data submission preferred
Project management skills in the context of software development preferred
Previous experience in the healthcare or finance industry preferred
Apply
My EmailPlease enter a valid email address to create job alerts.By clicking on "Continue", I give CareerBliss consent to process my data and to send me email alerts, as detailed in CareerBliss's Privacy Policy. I may withdraw my consent or unsubscribe at any time.Continue
