IT Specialist II - EDI - Inland Empire Health Plan

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 - EDI will work with the client implementation team to assist in the on boarding of new clients. The IT Specialist II - EDI will be responsible in evaluating the X12 transactions (999, 277CA and MAO’s – 837) as well as CSV formats. The IT Specialist II - EDI 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 - EDI 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.

Key Responsibilities:

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.

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; 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

Education & Experience

• High School diploma or GED required
  • Bachelor's degree from an accredited institution preferred
• 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 with client/server principles and techniques

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!