Analyst Developer EDI (Architect)

POSITION SUMMARY

The Analyst/Developer (Architect)-EDI 27X is responsible for the implementations and integrations of various enterprise solutions. Analyst/Developer-EDI 27X also helps the teams define and implement a technological solution which is suitable for hosting current and upcoming business and technical functional requirements.

ESSENTIAL FUNCTIONS

Manage Health Insurance Portability and Accountability Act (HIPAA) transactions.

Prioritize, research, track and resolve Electronic Data Interchange (EDI) related issues. Generate reports to assure all transactions are handled accordingly.

Implement and maintain 27X transactions

Resolves key technical impediments

Responsible for the scope and realization Architectural Reviews and Recommendations. This includes but not limited to architecture stories/diagrams, proof of concept, coding/programming, etc. for assigned project(s).

Works with key stakeholders , project managers and business owners to understand the upcoming requirements of new system or new project

Work with internal team members and vendors on new integrations and improve and scale current processes

Presents the technological vision of the solution during planning and design phases

Ensure good and up to date documentation of the architecture and implementation thereof; using methods & tools for a structured approach.

Driving an accepted implementation of architecture, by explaining, convincing, deciding; incl. validation and verification; architecture lifecycle management; teaming-up for results.

Evaluates design alternatives, and perform cost benefit analysis

Act within the total context, (business, organization, roadmaps, external world, etc.): driving for convergence; capturing / re-use of prior art and in- and external trends; know your stuff;

Inspect and adapt : solving issues and learning from them

Lead and manage overall solution integrations for new solutions into existing end to end solutions

Develop, execute and maintain end-to-end solution architecture, solution capacity and performance plan

Working with IT team, responsible to develop and deploy general audit principles, security administration processes and frameworks, metrics collection and reporting, which are compliant with State and Federal regulations including but not limited to CMS, HIPAA, etc.

Develop, deploy and maintain eSolutions (Portals, Mobile App, etc.), Claim/Enrollment and end to end Health plan management systems, etc. (Mid-to-Long term projects)

Plan, direct, and coordinate solution projects to ensure goals and objectives are accomplished within prescribed time frames and funding parameters.

Define and document solution architecture diagrams, process flow diagrams, data flow diagrams and/or status reports.

Use sound solution architecture methodology and demonstrate solid technical skills.

This position could be an Architect function in the future.

NOTE: The essential functions are intended to describe the general content of and requirements of this position and are not intended to be an exhaustive statement of duties. Specific tasks or responsibilities will be documented as outlined by the incumbent’s immediate manager. SCOPE AND COMPLEXITY

Position generally carries departmental responsibility within assigned discipline area. External customers may include, but are not limited to, regulatory/accrediting agencies, external data providers, etc. Internal customers include staff, managers, executives, and staff from parent companies.

PHYSICAL DEMANDS/ENVIRONMENT FACTORS

OE – Typical Office Environment: (Accountant, Administrative Assistant, Consultant, Program Manager)

Requires extensive sitting with periodic standing and walking.

May be required to lift up to 20 pounds.

Requires significant use of personal computer, phone and general office equipment.

Needs adequate visual acuity, ability to grasp and handle objects.

Needs ability to communicate effectively through reading, writing, and speaking in person or on telephone.

May require off-site travel

QUALIFICATIONS

Bachelors / University degree in related field or equivalent work experience required.

Minimum 7 years’ experience in Information Technology industry with 4-6 years of experiences in IT solution architect, software architect, enterprise architect or system architect experience

270/271 Transactions require knowledge of plan designs, basic plan configuration in the claims payment system and how this data is stored in the SQL data warehouse.

276/277 Transactions require knowledge of claims flow and how claims data is stored in the SQL data warehouse.

Knowledge of Health Insurance Portability and Accountability Act (HIPAA) electronic transactions

Familiarity with Project Management principles required.

Strong ITSM background required

PREFERRED QUALIFICATIONS

Master’s degree in Computer Science/Engineering, Information Solutions a plus

Experience in Healthcare and working with EDI integration systems would be a big plus.

Knowledge of Council for Affordable Quality Healthcare (CAQH) Committee on Operating Rules for Information Exchange (CORE) is a big plus.

Medicare Advantage/CMS/HIPPA Compliance experience a plus

Certificate in MCSE, TOGAF and/or CISSP a big plus

CAPM or PMP a big plus and required in 90 days of employment if the incumbent doesn’t have one

ITIL Foundation Certificate preferred and required in one year of employment if the incumbent doesn’t have one