Job description

People are the most important asset of Imperial, for this reason the difference and plurality of people, equality of opportunities, non-discrimination and inclusion in the workplace are priority and strategic factors in the Organization. Imperial maintains a strong will to promote Diversity, Equity, and Inclusion, through inclusive leadership as a lever change and business sustainability.

Imperial Health Plan of California, Inc. is approved by California Department of Managed Health Care to offer full-service Medicare Advantage coverage, including a Medicare Advantage Prescription Drug plan, and a Chronic Condition Special needs plan over numerous counties in California. Through its affiliate, Imperial Insurance Companies, Imperial also offers Medicare Advantage plans in Texas, New Mexico, Utah, and Arizona.

Mission is to deliver valuable care so that members are healthy in body, mind, and spirit to achieve their inherent potential.

Vision is to deliver value based care that is clinically effective, sustainable, and achieves exceptional outcome. Please be sure to check our company website at https://imperialhealthholdings.com

JOB SUMMARY:

Responsible for Electronic Data Interchange (EDI) ingestion, extraction, and reconciliation processes. The EDI II must understand data sets and formats such as XML, JSON, FHIR, and CALINX; as well as ANSI X12 /HL7 standards like 820, 834, 835, 837,277, 278 and 999. The EDI II will create or modify mapping documents based on our overall needs as well as the needs of high-profile projects, analyze requirements, test systems, export data in EDI formats, and be able to load and transform EDI files into accessible data formats. In addition to ingesting and exporting data, the EDI II will work with the business units on how to reconcile data by creating workflows and processes.

ESSENTIAL JOB FUNCTIONS:

1. Analyzes and defines EDI requirements for data ingestion and extraction

2. Creates workflows for data correction and error processing with business units

3. Performs data load and extraction from/to EDI file formats (XML/JSON/ANSI/HL7/FHIR)

4. Provides advice and education to internal team and vendors concerning EDI guidelines and capabilities.

5. Creates, develops, and produces mapping documents for both ingestion and extraction.

6. Collaborates with programmers and internal staff to develop and test new or modified systems.

7. Follows SDLC lifecycle processes to ensure efficient and effective data utilization for our business.

8. Develops and maintains communication links with trading partners and oversees integration of information.

9. Periodically reviews system to ensure client needs are met; identifies possible modifications as required.

10. Explains gaps and technical concepts for non-technical audiences as well as come up with solutions.

EDUCATION/EXPERIENCE:

· Bachelor's Degree in Computer Science, Management Information Systems, Public Health, Finance, Business, Economics, or related field required.

· In lieu of a Bachelor's Degree, 5 or more years collecting and breaking down high level EDI designs, fleshing out functional requirements, analyzing data, data mappings, and analyzing inter/intradepartmental processes in mid or large enterprise IT environment(s) required

· 5+ years of demonstrated experience in providing specifications on custom software that span Internet, Intranet, Extranet, integration, EDI and client/server architectures with multiple software development lifecycle's including waterfall and agile

· Must understand relational database concepts, table design and structure, joins, data normalization, and data types.

· Experience with HL7, ANSI, and FHIR standards are required.

· Experience with SQL (TSQL, PostgresSQL, MySQL etc.) is required.

· Experience with web service/API is preferred.

· Experience in Microsoft technologies including TFS, SSRS,TSQL, , .NET/C#, Dynamics365, Azure DevOps.

· Prior experience using ETL tools (Informatica, SSIS, dbt, fivetran etc.), Python, R, and BI visualization (PowerBI, Tableau, Looker etc.) tools a bonus.

· 2-4 or more years experience in a healthcare delivery or healthcare business setting preferred.

· EZCAP experience preferred.

SKILLS/KNOWLEDGE/ABILITY:

Thorough knowledge of MS Office Suite particularly Excel

Job Type: Full-time

Pay: $66,000.00 - $70,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Referral program
• Retirement plan
• Vision insurance

Schedule:

• 8 hour shift

Ability to commute/relocate:

• Pasadena, CA 91106: Reliably commute or planning to relocate before starting work (Required)

Experience:

• EDI: 2 years (Required)
• SQL: 2 years (Required)

Work Location: In person

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