$140,000–$150,000 Per Year
Analysis Skills, Business Intelligence, Centers for Medicare and Medicaid Services (CMS), Communication Skills, Computer Programming, Computer Science, Content Management Systems (CMS), Cross-Functional, Data Management, Data Processing, Data Quality, Database Administration, Database Analysis, Database Extract Transform and Load (ETL), Database Programming, Documentation, Electronic Data Interchange (EDI), Healthcare, Identify Issues, Information Technology & Information Systems, Maintain Compliance, Microsoft SQL Server, Microsoft Visual Studio, Performance Metrics, Power BI, Presentation/Verbal Skills, Problem Solving Skills, Procedure Development, Process Flow, Regulations, Regulatory Compliance, Regulatory Reports, Reporting Skills, SAP BusinessObjects, SQL (Structured Query Language), SQL Databases, SQL Server Integration Services (SSIS), SQL Server Reporting Services (SSRS), Stored Procedures, Tableau, Team Player, Test Data, Time Management, XML (EXtensible Markup Language)
Senior Electronic Data Interchange (EDI) Database Programmer
Job Ref: TE0153
Category: Professional
Department: ANALYTICS AND REPORTING
Location: 50 Water Street, 7th Floor, New York, NY 10004
Job Type: Regular
Employment Type: Full-Time
Work Arrangement: Hybrid
Salary Range: $140,000.00 - $150,000.00
Position Overview
The position of Senior Electronic Data Interchange (EDI) Database Programmer in Analytics and Reporting Department is responsible for managing encounter data submission to CMS (Centers for Medicare and Medicaid Services) and other regulatory entities as required. The responsibility includes troubleshooting EDI mapping issues, Encounter data reporting errors, monitoring CMS Encounter Data Quality reports like MAO002, MAO003, ensuring adherence to EDI standards, writing complex SQL Queries and stored procedures, SQL Server Integration Services (SSIS) jobs for EDI file submission and troubleshooting EDI error records. Developing and maintaining EDI documentation, including process flow, cross-functional team collaboration regarding identification of EDI problem areas. Preparing test data, conditions and expected results to verify new EDI updates and logic. Build ETL for claims extract, Enrollment Extracts, Supplemental extract for DentaQuest, InComm, ModivCare etc.
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.
Scope of Role & Responsibilities
- Monitor and submit Encounter Data files to CMS and NYSDOH.
- Collaborate with vendors/end users on correcting EDI error transactions and resubmissions to CMS.
- Maintain ETL data extracts for EDPS Data submissions.
- Support compliance and regulatory for any inquiry on encounter data processes.
- Support CMS reporting and other regulatory reporting.
- Create KPI reports on encounter data reporting.
- Create SQL stored procedures, SSIS packages, flow diagrams and document the process for Encounter Data Reporting.
- Develop and test EDI mapping for Encounter submissions.
- Troubleshoot EDI Errors using MAO002, MAO003 reports and keep track of all the resubmissions to CMS.
Required Education, Training & Professional Experience
- Bachelor's degree in information systems, Computer Science, or Database management required. Master's degree preferred.
- Minimum 10 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, Troubleshooting EDI Errors.
- Minimum 5 years' experience in complex healthcare data like Claims, Enrollment, Providers.
- Strong knowledge of EDI X12 Standards especially for transactions 837's, 834, 277CA, 999.
- Prior experience in submitting encounters to CMS is required.
- Previous experience in BI reporting tools, such as BusinessObjects, Tableau or Power BI.
- Health Edge's Health Rule Payor (HRP) backend table knowledge preferred
- Knowledge of Visual Studio, Net Development, XML
Professional Competencies
- Integrity and Trust
- Collaboration and Time management skills
- Functional/Technical skills
- Written/Oral Communication
- Teamwork
- Excellent analytical and problem-solving skills
- Ability to work effectively in a team environment and adapt to different projects and assignments quickly.
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Metroplus Health Plan Inc