Electronic Data Interchange (EDI) Business Analyst
- Job Location: Washington, DC
- Job Type: Full–Time
- Pay: Up to $95K/yr (Depends on Experience)
- Clearance: Those authorized to work in the United States without sponsorship are encouraged to apply.
- Travel: Up to 75%
DUTIES AND RESPONSIBILITIES:
The Health Benefit Exchange Authority (HBX) provides access to quality and affordable health care to all District residents and small businesses through Qualified Health Plans (QHPs) sold on the exchange marketplace. HBX is responsible for certifying QHPs that: meet certain qualifications (including the provision of essential health benefits); follow established limits on cost sharing; and meet other requirements.
Candidate will be part of team that shall provide ongoing technical operations and software maintenance support to include the following:
- Manage and maintain HBX IT infrastructure, including but not limited to AWS resources, code and release management, and ticketing system maintenance and management.
- Manage and maintain the systems related to how HBX transacts data with its trading partners.
- Ensure data maintained in HBX s related systems is accurate and consistent across all systems, and ensure corrections are made when there are deviations from the expected data.
- Identify the cause of production bugs or defects, develop the most efficient and effective fixes, and testing and deploying those fixes through the release management process to production.
- Ensure all core technology is maintained on a stable, currently supported version, and develop and implement upgrade plans in collaboration with HBX staff.
- Project management and oversight of ongoing O&M activities to ensure HBX priorities and requirements are being met.
- Operate, maintain, and enhance EnrollApp, Glue, and related systems in accordance with applicable security and compliance requirements, under the direction of HBX staff.
- Quality assurance testing and validation of all work.
- Supporting HBX staff in the annual plan and rate loading and testing processes with third parties.
REQUIRED SKILLS AND EXPERIENCE:
- 5+ years of experience managing IT projects using Agile development methodology, from requirements gathering through delivery, including project budget management.
- Must have strong Electronic Data Interchange (EDI) experience.
- Strong understanding of business rules.
- Claims, enrollment and pricing configuration is a plus.
- Must have strong previous experience in the HIPAA transaction set.
- 5+ years of experience working in a payer or provider environment.
- Healthcare operational experience is not required, but is highly preferred.
- 5+ years of IT Business Analysis experience gathering/documenting business requirements and translating into technical specifications.
- General knowledge of healthcare operations, payer business processes and/or provider and Electronic Data Interchange (EDI) infrastructures.
- Excellent organizational, and communication skills (verbal and writing).
- Self–starter, problem solver and willing to travel up to 50–75%
- Previous leadership assignments and project management experience a plus.
- Experience in HIPAA logical mapping and system implementation is preferred.
- Strong experience with XML and XSLT. Need to be able to map Electronic Data Interchange (EDI) and flat files to XML Schemas and vice versa. Experience with XMLSpy a plus.
- Experience with QA Methodology and QA Validations to ensure the Quality Assurance Control
- Experience in creation and interpretation of Business specifications and Develop Test Plans, Test Scripts and Test Cases and Execution Experience in implementation of payer or provider applications examples. (AMISYS, HealthRules, Facets, IDX, QuadraMed, QNXT, Power MHS, Diamond, etc.). Bachelor s degree or equivalent in a relevant field.
- Ability to work with TransSend using all or most of the following technologies: MS SQL Server 2005 and higher or PL/SQL, VB, Java, UNIX, C and C++. Clearly articulate (both verbal and written) project status and issues management.
- Technology Expertise in Rubi on Rails, MongoDB, Oracle, B2B Gateway, Curam, Java, Salesforce