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Systems Analyst - EDI Management

Job ID 85606 Date posted 01/20/2018
  • Facility: Sharp HealthPlan
  • City: San Diego
  • Department: Finance
  • Category: IT Jobs
  • Job Status: Full-Time
  • Shift: Day Job
  • FTE: 1.0
  • Shift Start: Variable
  • Shift End Time: Variable
Location
This position is located in Kearny Mesa, San Diego County
 
Hours
8-hour shift: 8:00 am – 5:00 pm, weekends as needed.
 
Required Skills and Qualifications
  • BA/BS in health care administration or planning, information systems, computer science or related field recommended.
  • Demonstration of professional level of knowledge of health plan operations, health plan software configuration, enrollment and claim file processing and trading partner management, and data processing environments.
  • Experience analyzing complex issues and/or requests to provide effective solutions with the ability to identify root cause, communicate options and propose solutions.
  • Knowledge of health care related EDI transaction sets.
  • Familiarity with data communications standards and system configuration.
  • Extensive knowledge of IDX, Facets, QNXT, Healthedge, HPS, and/or other administrative systems within the health plan insurance industry
 
Preferred Skills and Qualifications
  • Two years’ previous experience as systems analyst within a large Health Plan

Summary
Under the direction of the Supervisor of EDI Management, the Systems Analyst-EDI Mgmt will support the Data Management staff in problem solving claims, enrollment and eligibility and other data issues and implementing new software applications, EDI formats and mappings, and developing reports and data extractions for the ultimate goal of streamlining processes and improving service to internal and external customers.
This might be the job for you if you are:
  • A self-starter who has a knack for implementing order and processes in a SQL environment
  • Someone who thrives in fast-paced environments with multiple deadlines and deliverables
  • An excellent communicator (verbal and written)
  • Someone who can write SQL queries,  and possesses excellent analytical skills to interpret and understand the data
  • Good at creative problem solving and decision-making
  • Someone who possesses an eye for detail
  • A team player who can effectively manage up and across an organization
  • Good at working with cross-functional teams

Here's what Sharp Health Plan has to offer you:

Sharp Health Plan is the largest, locally-based commercial health plan in San Diego. We are a not-for-profit organization serving the needs of San Diegans since 1992. As a subsidiary of Sharp HealthCare, San Diego’s largest provider of health care services, we not only serve the people of San Diego, we are the people of San Diego.

Through our unique integration with Sharp HealthCare, we connect our members to an award-winning network of hospitals, medical groups and physicians. We offer health insurance options for individuals, families, groups and businesses that combine affordability, choice, high-quality health care and personal service.

Sharp Health Plan is the highest member-rated Health Plan among reporting California Health Plans.* We're also accredited by the National Committee for Quality Assurance (NCQA) with a status of Commendable which is awarded to organizations with well-established programs for service and clinical quality. We continually strive to improve the quality of our services and benefits, and seek innovative solutions to today’s complex health care issues. From helping you find the right health plan to the right doctor to being a great place to work, we’re here for you!

If you like the sound of what it means to be a Sharp Health Plan team member, and you meet the qualifications above, please submit your resume along with a brief explanation about why you would be a good fit for this position. We look forward to hearing from you. 

*The source for this data is Quality Compass® 2016 and is used with the permission of the National Committee for Quality Assurance (NCQA). Quality Compass® 2016 includes certain CAHPS® data.

Sharp HealthCare is proud to be an Equal opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, gender identity, transgender status, sexual orientation, protected veteran status or any other protected class.

Keywords:  Health Plan data management, finance, EDI processing, EDI transaction

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