Engineer I - Business Systems

Inland Empire Health Plans    Rancho Cucamonga, CA
Job Description
Job Requisition ID: 3443

Position Summary/Position
Under the direction of management the Business Systems Engineer is responsible for managing moderately complex system configurations within Core Business Systems.

The Business Systems Engineer is responsible for configuration design, build, testing and implementation of low to moderately complex system builds; understanding the interrelated dependencies within IEHPs Core business systems, in fulfillment of regulatory and business process needs of IEHP, CMS and DHCS. The Engineer is as a subject matter expert for the business areas by helping to drive decisions related to complex system configuration through proven experience and analysis of process and results. The position will translate business to technical specifications, and develop and maintain comprehensive documentation. The Engineer I will facilitate communication and formally report findings to various department heads and staff in a manner that is appropriate to the skill level and technical expertise of the audience. This position will be required to train and help educate other team members within the unit as necessary.

Major Functions (Duties and Responsibilities)
1. Configure and maintain moderately complex system builds with multi-tiered functionality and interrelated system dependencies, within the area of e3xpertise assigned. For Example claims: including but not limited to Transforms, Contracts, Batch Jobs, Explanations, Fee Schedules, Claim Payment Rules, and Modifier Reduction schedules
2. Participate in cross functional teams to develop a comprehensive functional and systems level solution test strategy that accounts for the common aspects of the solutions, including cross functional review for such plan
3. Design & develop test plans and test cases to ensure and gauge product quality, while effectively minimizing manual testing - manage creation of test plans, test scripts and test cases and lead in their execution and perform Debugging and Root Cause Analysis on test failures
4. Assist with the development of configuration standards and best practice guides for maintaining efficiency, accuracy, automation and successful integration with internal and external systems and programs
5. Analyze and identify system enhancement needs based on standard metrics and business operational requirements
6. Effectively interpret and train staff on new functionality and assist in updating Desktop Reference material for interdepartmental stakeholders
7. Analyze and translate business specifications into detailed technical specifications based on system functionality, and develop non-systematic workaround processes when necessary
8. Track incoming requests and issue resolution through Access and Workfront tools
9. Identify and communicate impact of system enhancements or configuration changes on integrated systems and processes
10. Monitor and work daily System Configuration inventory and ensure compliance with established service level agreements and regulatory timelines
11. Assist Contracting team with drafting appropriate contract fee schedule language to be in line with system adjudication capabilities
12. Track, test, and approve new system functionality, enhancements, and bug fixes, including the development and execution of test plans and scripts
13. Effectively work in collaboration with dependent business units with frequent and positive communication and teamwork
14. Any other duties as required to ensure Health Plan operations are successful.
15. Ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP s policies and procedures relating to HIPAA compliance.

Education Requirement
High school diploma or GED
Preferred Education
Bachelor’s degree preferred – Field of study: IT, Finance, Project Management, HealthCare.

Knowledge Requirement
1-2 years of experience with the development and remediation of moderately complex system configurations, including capitated agreement configurations required

Knowledge of Medicare and Medi-Cal benefit structure and regulatory billing guidelines required

Skilled in the use of Microsoft Excel and Access -required

Knowledge of CMS, DHCS, DMHC, NCQA rules and regulations preferred

For claims area of expertise - Extensive knowledge of CPT, HCPCS, Revenue, ICD10 coding rules and guidelines and familiarity with basic medical claims processing

For eligibility area of expertise – Extensive knowledge of group, benefits, membership data, copays, correspondence requirements and member eligibility.

Experience in major managed care system migration/implementation preferred

Extensive knowledge of general managed care operations required, delegated plan model preferred

Abilities Requirement
Proficient knowledge of relational database structure

Ability to work independently and solve complex problems with little to no assistance

Exceptional problem solving and critical thinking skills

Strong presentation and written communication skills

Ability to effectively manage multiple competing priorities

Effective task and project organization skills

Able to build relationships with dependent teams and communicate

Working Conditions
Makes necessary adjustments to work shift ensure completion of projects and to meet deadlines, e.g., system releases, system implementation critical path milestones.

Starting Salary: $54,724.00 - $69,784.00

Pay rate will commensurate with experience

Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 6,000 and a team of more than 2,000 employees, IEHP provides quality, accessible healthcare services to more than 1.2 million members. And our mission and core values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and Make a Difference with us! IEHP offers a Competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and retirement plan.

Thu, 22 Aug 2019 21:29:32 GMT

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