IT Specialist II - EDI

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!

The IT Specialist II will work with the client implementation team to assist in the on boarding of new clients. The IT Specialist II will be responsible in evaluating the X12 transactions (999, 277CA and MAO’s – 837) as well as CSV formats.  The IT Specialist II will also manage file transmissions and continuously strive to improve the department processes and procedures and ensure efficient workflows within the Operation - IT. They will be responsible for any testing that occurs during new client implementations and client transitions to other eligibility methods. The IT Specialist II will also be a key component in the claim generation process and creation of data to create an X12 837 file for claim submission.

 The position will participate in design and development of client/server systems which utilize pre-defined file formats for all vendors, in addition to SQL Server-based reporting and assist database security.

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

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

• Competitive salary
• Hybrid schedule
• State of the art fitness center on-site
• Medical Insurance with Dental and Vision
• Life, short-term, and long-term disability options
• Career advancement opportunities and professional development
• Wellness programs that promote a healthy work-life balance
• Flexible Spending Account – Health Care/Childcare
• CalPERS retirement
• 457(b) option with a contribution match
• Paid life insurance for employees
• Pet care insurance

1. Analyze, design, develop, test, troubleshoot, enhance, and maintain EDI transaction sets in various formats that include 837, TA1, 999, 277CA and MAO’s and EVR’s as well as HTML formats
2. Maintain detailed documentation and process flow of all EDI processes.
3. Evaluate client requests for new EDI features and give suggestions to direct manager.
4. Participate in project meetings providing input to project plans and providing status updates as required.
5. At the request of end users or management, research questions involving EDI applications and how the data is organized and populated.
6. Provide status updates on all assigned tasks.
7. Manage and ensure quality and consistent delivery for EDI Encounter transactions (837)
8. Ensure correct mapping to response data (837, 999, 277CA and MAO’s) to any 837 submissions.
9. MS SQL Server 2012, SSIS, SSRS, SSAS and Data warehousing/data modeling concepts preferred.
10. Test with Trading Partners for compliance within regulatory and environmental changes as they relate to ANSI transactions.
11. Use Quality Assurance measures to troubleshoot and resolve issues related to all aspects of file data loading and processing.
12. Any other duties as required to ensure the Health Plan EDI operations are successful.
13. Ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP's policies and procedures relating to HIPAA compliance.

Education & Requirements 

• The following experience may be concurrent:
  • Two (2) years in data extraction, transformation, and loading (ETL)
  • One (1) year in database administration and development, using Microsoft SQL Server or similar relational database application
  • One (1) year programming with Structured Query Language (SQL)
• Experience preferably in a health care setting
• High School diploma or equivalent
• Bachelor's degree from an accredited institution preferred

Key Qualifications

• Techniques of relational database analysis, design, and implementation, including data mining and transformation techniques
• Principles and practices of project control, physical and logical security techniques
• Demonstrated strong analytical skills
• Excellent customer service with both internal and external customers. Excellent verbal and written communication skills
• Ability to read and process ANSI X12 files formats
• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers
• Ability to meet deadlines and work within a deadline driven department

Start your journey towards a thriving future with IEHP and apply TODAY!

This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA.)