Application Developer III
Position Purpose: This position is responsible for a variety of duties related to the provisioning, onboarding, and support of all claim environments and supporting interfaces.
- Provide development support for migration of lines of business from MedMC onto QNXT
- Interfaces to ancillary systems (eVips, EDM, Cotiviti/Verscend, Claims Workflow, AHCCCS Member Demographic DUGLess, etc.)
- Support system configurations including required rule & edit customizations (QNXT Auto-Q: Dup edit, Max Unit edit, Conflicting Services edit, COB edit corrections, COB pricing, etc.)
- Support the automated solution that imports (new, changes, terms) provider data (Demographic, Affiliations, etc.) from sources including MedMC, SalesForce, and soon to be eVips.
- Provide mentorship and cross training to other team members
- Support the EDI 834 application that imports and translates regulator sourced EDI 834s for all affected lines of businesses (SHCA enrollment types: ACC, RBHA, State-Only, Crisis, GOSUD; Mass Health Model B/A, Utah Medicaid, etc.) for import into the GlobalMembers database that feeds Care Radius, QNXT, Pharmacy Benefit Manager, etc.
- Support the Claims Mergerator application that automates the separation and merging of acute claim files for import into MedMc as well as outbound EDI 837 files to AHCCCS.
- Support the Claims Investigator solution, which obtains and stores EDI 837 file details into tables to support inventory reporting. This solution supports the full tracking of all claim file information on re-merged/outbound files.
- Support and close all tickets from operations for enhancements and modifications to claims adjudication systems or related interfaces
- Develop and maintain SSIS packages to import data from various 3rd party vendors and to export data in a variety of standard formats that meet both business and state contractual requirements
- Identify opportunities for legacy package improvements, build out plan and execute on redesign
- Create and maintain SQL databases, tables, views and other database objects
- Document processes workflows, training materials and other standard IT documentation
- Troubleshoot and fine tune stored procedures for optimal performance
Education / Experience / Other Requirements
This position requires a Bachelor’s degree in a Computer Science related field with additional exposure to health plan claiming environments, or an equivalent combination of education and experience sufficient to successfully perform the essential duties of this position.
Years of Experience:
Three years of experience in healthcare, analytics, statistical analysis (regression, KPIs, sampling, risk analysis), performance improvement or data and outcomes measurement; or an equivalent combination of education and experience sufficient to successfully perform the essential duties of this position is strongly preferred, or an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position.
The position requires a high attention to detail and ability to work under pressure, in conflict situations, and under strict deadlines. Additional skills and knowledge include:
Job Status: Full Time
Job Reference #: 13229