IEHP

Engineer III - EDI

IEHP  •  Hybrid  •  2 months ago
Apply
Save Job
Mark Applied Mark Interviewed Mark Offered
Hide Job Report Job
AI can make mistakes so check important info. Chat history is never stored.

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!

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.

    IEHP

    About IEHP

    With a mission to heal and inspire the human spirit, Inland Empire Health Plan (IEHP) is one of the top 10 largest Medicaid health plans, the largest not-for-profit Medicare-Medicaid public health plan in the country, and for the fourth year in a row, certified as A Great Place To Work®. Founded in 1996, IEHP supports more than 1.5 million Riverside and San Bernardino County residents enrolled in Medicaid or IEHP DualChoice (those with both Medi-Cal and Medicare). As of 2024, IEHP also offers Covered California plans, further ensuring health care access for even more IE residents. Today, IEHP has a robust network of quality doctors throughout our two counties and nearly 4,000 team members who are fully committed to the vision: We will not rest until our communities enjoy optimal care and vibrant health. To learn more, go to iehp.org.

    Comprehensive Benefits

    Competitive salary and a benefits package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and retirement plan.

    Mission: To heal and inspire the human spirit.

    Vision: We will not rest until our communities enjoy optimal care and vibrant health.

    Values: We do the right thing by: Placing our Members at the center of our universe; unleashing our creativity and courage to improve health and well-being; bringing focus and accountability to our work; and never wavering in our commitment to our Members, Providers, Partners, and each other.

    Winning Team Culture

    Certified as A Great Place To Work® four years in a row.

    Industry
    Healthcare & Social Services
    Company Size
    1,001-5,000 employees
    Headquarters
    Rancho Cucamonga, CA
    Year Founded
    1995
    Website
    iehp.org
    Social Media