Health Plans Developer III

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POST DATE 8/23/2016
END DATE 11/10/2016

Christus Health Irving, TX

Company
Christus Health
Job Classification
Full Time
Company Ref #
5000131745706
AJE Ref #
575959220
Location
Irving, TX
Experience
Mid-Career (2 - 15 years)
Job Type
Regular
Education
Bachelors Degree

JOB DESCRIPTION

APPLY
Description

The Health Plans Developer III reports to the Director of Health Plan Services, in the Information Management (IM) department, is primarily responsible for Tier III activities related to translating business requirements to design and then into working code that handles custom data formats, workflows and rules as it relates to key Health Plan technology systems. Specifically, the position works closely with CHIRISTUS Health Plan directors, managers, application users, and other IM teams as it relates to data integration, process documentation, business requirements analysis, development of ad hoc and standard reports, and testing of electronic transactions. This position provides Incident, Problem Request, and Change managmenet supporting and following ITIL best practices. As a senior level team member, this position shares information and assists other junior level team members while providing quality suppot to both internal an dexternal users with a focus on customer service and timeliness.

* Provides/coordinates resolution of issues while recommending procedures and controls for problem prevention, escalation, etc.
* Follows the outlined Service Management Processes including issue/request SLA and SEV1 and 2 application outages.
* Responsible for thorough documentation within call tracking database and knowledge database to document work around or resolution of frequent incidents to enhance quality of problem resolutions for future incidents.
* Coordinates code changes with appropriate vendor related to financial and business application issues.
* Collaborates with various IM teams to identify and infrastructure related issues that have resulted in application issues.
* Aggressively manages personal workload related to open issues and service requests to ensure agreed upon SLA's are met.
* Provides/coordinates resolution of issues while recommending procedures and controls for problem prevention, escalation, etc.
* Follows the outlined Service Management Processes including Incident, Change, Problem, Request management.
* Provides thorough documentation within call tracking database and knowledge database to document work around or resolution of frequent incidents to enhance quality of problem resolutions for future incidents.
* Plans, analyzes, researchs, designs, codes, deploys, tests software applications in SQL server, .net, SSIS, SSRS, XSLT and crystal reports
* Develops reports and extracts as per specifications and requirements
* Analyzes business requirements and documents functional requirements
* Prepares technical design documents
* Guides and assists development team in deciding best approaches and practices
* Leads and participate in peer review and unit testing of applications
* Provides Tier III support and maintenance of all Health Plan applications
* Migrates data from multiple systems
* Works with the business and the IM team regarding application configuration changes and system upgrades
* Provides guidance to end users during user acceptance testing
* Prepares weekly status report for tasks assigned
* Develops healthcare EDI X12 files as per vendor companion guide
* Works with end user to discuss on solutions, concerns and suggestions
* Demonstrates strong communication and human relationship skills.
* Provides effective customer service by being courteous, polite and friendly at all times. Acknowledge customers timely in order to determine their need and help the customer resolve the issue or request. Participate in departmental programs that promote and deliver exceptional customer service.
* Performs other duties and special projects as requested Pursue professional growth and development through personal reading, seminars, workshops and professional affiliations to keep abreast of the trends in his/her field of expertise. May be required to travel to perform duties.
* May be required to work outside of normal working hours.
* May be required to work long hours during critical problems or implementations.

Requirements

A. Education/Skills
* Bachelor's Degree or combined equivalent experience.

B. Experience
* Advanced skills in C# .net, SQL, SSIS, SSRS and Crystal Reports
* Working knowledge in XML, XSLT, REST, WCF, LINQ, ASP .net and batch commands
* Working knowledge of the Affordable Care Act/Health Insurance Exchange Medicaid, Medicare, and Commercial Health Plans
* Functional expertise in enrollment processing, claim processing, provider contracting and pricing, EDI (HIPAA Transactions) processing, integration
* Advanced skills with HSP, QNXT solutions, including: Hosp & Medical Claims, Processing Control Agent / Set Up, Product Build from Summary, Pricing, Provider - Networks/Relationships,
* Knowledge of EDI Healthcare Transactions (820, 270, 271, 834, 837, 270, 271 etc...)
* Strong technical experience in EDI Mapping tools , Trading Partner Configuration, Databases (SQL Server), Reporting, Sharepoint, Microsoft Office Suite - Excel, Access, PowerPoint, etc.
* Knowledge of industry standard health data and code sets such as ICD-10, CPT/HCPCS, Revenue codes, 5010, NCPDP Eligibility / Enrollment Data Model & Structure, Member/Eligibility Input & Output Feeds
* Working knowledge of relational databases and structure with 5+ years of recent experience in writing Stored Procedures, User Defined Functions, Views, using SQL Server and 5+ years of recent experience with Microsoft technologies such as .NET and SSIS/SSRS.


C. Licenses, Registrations, or Certifications
* None