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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.
Responsible for BRDs creation and communication with Trading Partners.
Work independently, often working directly with business users and IT groups to understand and document requirements.
Work cross-functionally with department leaders to deliver actionable analyses/results.
Present findings of analyses to various staff levels.
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
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.
Ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP’s policies and procedures relating to HIPAA compliance.

Requirements

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
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

Benefits

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

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

SQLSSRSEDIFECSdata analysisBRD creationLEAN principlesdata trackingsubmission remediationHIPAA complianceX12 formats

Soft Skills

problem-solvinginterpersonal skillscommunication skillsattention to detailproject managementrelationship buildingindependent workcross-functional collaborationanalytical thinkingpresentation skills