What are the responsibilities and job description for the Managed Care Organization EDI Developer - Managed Care Operations - FT Days position at University of California, Irvine?
Overview:
Required Qualifications:
Preferred Qualifications:
Conditions of Employment:
Closing Statement:
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 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. Listed among America’s Best Hospitals by U.S. News & World Report for 23 consecutive years, UCI Medical Center provides tertiary and quaternary care and is home to Orange County’s only National Cancer Institute-designated comprehensive cancer center, high-risk perinatal/neonatal program and American College of Surgeons-verified Level I adult and Level II pediatric trauma center, gold level 1 geriatric emergency department and regional burn center. UCI Health serves a region of nearly 4 million people in Orange County, western Riverside County and southeast Los Angeles County.
To learn more about UCI Health, visit www.ucihealth.org.
Responsibilities:
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 rexchanges 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.
Qualifications:
Total Compensation
We offer a wealth of benefits to make working at UCI even more rewarding. These benefits may include medical insurance, sick and vacation time, retirement savings plans, and access to a number of discounts and perks. Please utilize the links listed here to learn more about our compensation practices and benefits.
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
Conditions of Employment:
The University of California, Irvine (UCI) seeks to provide a safe and healthy environment for the entire UCI community. As part of this commitment, all applicants who accept an offer of employment must comply with the following conditions of employment:
- Background Check and Live Scan
- Employment Misconduct*
- Legal Right to Work in the United States
- Vaccination Policies
- Smoking and Tobacco Policy
- Drug Free Environment
- Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts a conditional offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer.
The following additional conditions may apply, some of which are dependent upon business unit or job specific requirements.
- California Child Abuse and Neglect Reporting Act
- E-Verify
- Pre-Placement Health Evaluation
Details of each policy may be reviewed by visiting the following page: https://hr.uci.edu/new-hire/conditions-of-employment.php
Closing Statement:
The University of California, Irvine is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected categories covered by the UC nondiscrimination policy.
We are committed to attracting and retaining a diverse workforce along with honoring unique experiences, perspectives, and identities. Together, our community strives to create and maintain working and learning environments that are inclusive, equitable, and welcoming.
UCI provides reasonable accommodations for applicants with disabilities upon request. For more information, please contact UCI's Employee Experience Center (EEC) at eec@uci.edu or at (949) 824-0500, Monday - Friday from 8:30 a.m. - 5:00 p.m.
We are committed to attracting and retaining a diverse workforce along with honoring unique experiences, perspectives, and identities. Together, our community strives to create and maintain working and learning environments that are inclusive, equitable, and welcoming.
UCI provides reasonable accommodations for applicants with disabilities upon request. For more information, please contact UCI's Employee Experience Center (EEC) at eec@uci.edu or at (949) 824-0500, Monday - Friday from 8:30 a.m. - 5:00 p.m.
