This position is responsible for a variety of duties related to the provisioning, onboarding, and support of Health Choice enterprise managed care applications and solutions.
- Design, develop, and deploy extensible and supportable software solutions that address the needs of Health Choice stakeholders, providers, members, and other trading partners, and are consistent with industry, State, Federal (Ex. CMS, HHS, SAMHSA, OIG, etc.) regulatory standards (HIPAA, CMS Interoperability and Patient Access, CURES Act, etc.)
- Analyze the needs of internal and external Health Choice customers relating to the collection, maintenance, exchange, and delivery of managed care information solutions that support operational, Provider/Network (Credentialing, Contracts, PDM), Utilization, Clinical, Financial, Quality, Call Center, Membership (eligibility, demographic, etc.) and reimbursement services’ initiatives.
- Utilize various ETL technologies (MS BizTalk, MS SSIS, EdiDev, etc.) that support the development and maintenance of ETL solutions, which exchange various data streams and constructs with external trading partners (Vendors, providers, and health care regulators, etc.) using a variety of proprietary and standardized interchange methodologies (sFTP, Compression, encryption) and formats (NCPDP, HL7, ANSI X.12 EDI 837i,p,d, 834, 835, 278, 270/271, 276/277, JSOM, XML, CSV/Pipe, Tab, etc.)
- Define, diagram, and document Standard Operating Procedures, Business Requirements, Functional Design Specifications, ERDs, process/workflow models, Data Dictionaries, End-User Documentation, and Unit and Test plans/cases in/with Team Foundation Server (TFS) and Confluence (IS Knowledge Base)
- Utilize MS Visual Studio and Team Foundation Server (TFS) in an agile and collaborative team oriented development environment (Scrum and Agile knowledge and experience desirable). Use TFS GIT or Native Source Control functionality to preserve all source code.
- Utilize business intelligence technologies to develop, deliver and support enterprise dashboards, reports, automations solutions, and ad hoc extracts
- Participate in business requirements meetings to gather and document business requirements. Help to define functional requirements needed for internally-developed solutions
Education / Experience / Other Requirements
Years of Experience:
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