Data Engineer (EDI, claims)

at  MetroPlus Health Plan

Job Ref: 117607
Category: Information Technology
Department: ANALYTICS AND REPORTING
Location: 50 Water Street, 7th Floor, New York, NY 10004
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $125,000.00
Salary Range: $125,000.00 - $135,000.00

POSITION OVERVIEW

The position of Data Engineer in the Analytics and Reporting Department is responsible in managing encounter data submission to NYSDOH, CMS and other regulatory entities as required. The responsibility includes troubleshooting EDI mapping issues, Encounter data reporting errors, monitoring Encounter Data Quality reports, ensuring adherence to EDI standards, writing complex SQL Queries and stored procedures, SSIS jobs for EDI file submission, and troubleshooting EDI error records. Additionally, this role is responsible for developing and maintaining EDI documentation including process flow and cross-functional team collaboration regarding identification of EDI problem areas. Lastly, the Data Engineer is responsible for preparing test data, conditions and expected results to verify new EDI updates and logic.
The successful candidate must have strong SQL programming skills, EDI Analytical skills, communication skills, and healthcare experience with knowledge in membership, provider, and claims data.

JOB DESCRIPTION

• Monitor and submit Encounter Data files to NYSDOH OSDS and CMS.
• Collaborate with vendors/end users on correcting EDI error transactions and resubmissions to NYSDOH and CMS.
• Automate manual processes for Encounter Data submissions.
• Support the Compliance and Regulatory department for any inquiry on Encounter Data processes.
• Support MMCOR reporting
• Create KPI reports on Encounter Data reporting.
• Create SQL stored procedures and flow diagrams and document the process for Encounter Data Reporting.
• Troubleshoot EDI Errors and keep track of all the resubmissions.

MINIMUM QUALIFICATIONS

• Bachelor’s degree in information systems, Computer Science, Database Management, or related field.
• Minimum 5 years of programming experience in SQL Server database object development including but not limited to stored procedures, functions, views, SSIS and SSRS, X12 EDI mapping and development, and troubleshooting EDI errors.
• Minimum 3 years’ experience in complex healthcare data like Claims and Enrollment.
• Strong knowledge of EDI X12 standards
• Previous experience in BI reporting tools, such as BusinessObjects, Tableau, or Power BI
• Knowledge of Visual Studio, .NET Development, XML, BizTalk.

Please refer the Job description for details