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About Us

Programmer / Analyst

The incumbent in this position is responsible for providing processing support of various EDI files, performing quality assurance data analysis, standard & ad hoc report development, provide support for ad-hoc report requests, and act as a liaison between SFHP and external data partners, including State and other contractual/regulatory agencies. 

 

ESSENTIAL DUTIES & RESPONSIBILITIES

  • Daily inbound and outbound EDI processing support; ensure processes are completed on time; performing necessary QA; assess and communicate any issues related to these processes with internal/external entities when necessary.
  • Assist with requirements gathering as needed.
  • Perform ad-hoc data analysis and QA; propose and execute solutions to data issues
  • Assist with establishing best QA practices
  • Report development in support of business operations and assist with report automation.
  • Analyze various health care data from conceptualization through presentation of the data.
  • Build and maintain reliable customer service to internal and external entities.
  • Collaborate with internal business units to create and document analysis specifications.
  • Identify data anomalies and gaps; propose solutions.
  • Performs other related duties and special projects as assigned.

 

CORE COMPETENCIES / KNOWLEDGE & SKILL REQUIREMENTS

  • In depth knowledge of HIPAA/EDI X12 4010/5010 healthcare-related file formats including 834, 837, and NCPDP formats.
  • Ability to synthesize data from various sources and perform various types of data analysis.
  • Moderate skill level using SQL programming language, MS Access, and/or MS Excel.
  • Familiarity with standard regulatory reporting requirements such as HEDIS measures.
  • Familiarity with industry standard health data code sets such as ICD-9/ICD-10, CPT/HCPCS, revenue codes, and NDC (Pharmacy).
  • Strong organization, time management and multi-tasking abilities.
  • Solid analytical skills and problem solving skills with the ability to formulate and communicate recommendations for improvement.
  • Have the ability to work effectively with others and have good interpersonal skills.
  • Be highly organized and work well under pressure.
  • Must be willing to accept responsibility and to show good judgment, initiative, and resourcefulness.

 

EDUCATION, EXPERIENCE & TRAINING REQUIRED
  • Bachelor’s degree or higher in relevant field (or 5 years of working in similar capacity).
  • Minimum 2-3 years of proven ability to interpret data in order to locate anomalies and recommending corrections plans.  
  • Minimum 2-3 years of experience in analysis of healthcare data (pharmacy, encounter, and membership), including knowledge of relevant code sets (diagnosis, procedure, revenue codes).
  • Minimum 2-3 years of intermediate SQL skills (preferably MS SQL Server).
  • Minimum 2-3 years experience using Microsoft Excel to perform analysis and create reports
  • Familiarity with various reporting tools such as SQL Server Reporting Services, Crystal Reports, or Cognos.
  • Minimum 2-3 years of data analysis.
  • PC literacy required; MS Office skills (Outlook, Word, Excel, PowerPoint)

Interested candidates should apply on line at:

https://home.eease.adp.com/recruit/?id=36042