"Managed Care Organization EDI Developer - Managed Care Operations - FT Days"

Position Summary: Position supports the Managed Care operations of UCI Health with respect to development, implementation and ongoing maintenance of all inbound and outbound Electronic Data Interchange (EDI) transactions for a managed care group. Incumbent will work with claims and payment teams on the HIPAA 837 -Health Care Claim and 835-Health Care Claim Payment/Advice, including working with Cirius and Office Ally. Additionally, position oversees ingestion of membership and eligibility files, lab and pharmacy data exchanges and care-gaps files from health plans. Incumbent is responsible for all health plan reporting requirements required by health plan contracts. The incumbent will work collaboratively with information systems staff, government and third-party payers, clearinghouses, and Epic technical support personnel to implement these transactions in an integrated, efficient, and cost-effective manner. This position will have responsibility for planning, implementing and managing HIPAA EDI projects relating to these transactions, including end-user contact, analysis, design, mapping, programming, training and documentation.

Required Qualifications:

• Strong project management skills including the ability to effectively manage multiple projects and tasks simultaneously
• Strong critical thinking and problem-solving skills to manage complex information, assess problems, and develop effective solutions
• Self-motivated and works independently on projects, from conception to completion and able to meet deadlines
• Must possess the skill, knowledge and ability essential to the successful performance of assigned duties
• Experience with file formats and reporting including but not limited to HCFA EDI or HL7, FHIR formats, CALLINK, RxHub
• Excellent organization and project management skills
• Demonstrated excellent organizational skills and possess the ability to design, set up and manage internal processes and protocols
• Demonstrated excellent interpersonal skills
• Demonstrated ability to communicate technical information to technical and non-technical personnel at various levels in the organization
• Associate's Degree in Business, Finance, Health Information Technology, or another related field
• Advanced written and verbal communication skills with the ability to convey complex information in a clear, concise manner
• Advanced knowledge of business and data process analysis functions
• Ability to maintain a work pace appropriate to the workload
• Ability to be forward thinking and anticipate problems and solutions
• 5 years of experience Electronic Data Interchange (EDI) experience

Preferred Qualifications:

• Revenue Cycle (healthcare business, financial or insurance) experience
• Prior experience with HealthPlan and EDI providers
• Prior EPIC experience
• Office Ally experience
• Knowledge of medical and insurance terminology, CPT, ICD coding structures, and billing forms (UB, 1500)
• Knowledge of University and Medical Center organizations, policies, procedures and forms

About UCI Health: UCI Health is the clinical enterprise of the University of California, Irvine, and the only academic health system based in Orange County. UCI Health is comprised of its main campus, UCI Medical Center, a 459-bed, acute care hospital in Orange, Calif., four hospitals and affiliated physicians of the UCI Health Community Network in Orange and Los Angeles counties and ambulatory care centers across the region. Learn more at www.ucihealth.org.