The Whole Person Care (WPC) Data Analyst will assist in the design and development of data feeds, electronic data interface, data flow and monitor files for Whole Person Care. This individual will work closely with internal departments and counterparts within health plans during implementation and through ongoing operations. Occasionally consult with non-technical business customers to determine requirements and apply the business rules to the data.
· Closely working with DHCS/DMHC and other external entities and assisting with development of new business requirements and functional specifications as they relate to Whole Person Care
· Analyze, develop, test, maintain and support complex data/process models, integration and processes in an EDI/ETL environment
· Review data to determine operational impacts and needed actions; elevate issues, trends, areas for improvement and opportunities to management.
· Perform root cause analysis for issues and provide effective and timely resolution
· Experience and familiarity with various types of healthcare-related data—membership, claims, laboratory, pharmacy, authorizations, EDI, HL7 etc.—utilized in healthcare organization that take insurance risk.
· Strong organizational skills that reflect ability to perform and prioritize multiple tasks seamlessly with excellent attention to detail.
· Highly resourceful team-player, with the ability to also be extremely effective independently.
· Performing writing, reporting, and analysis skills
· Communicating effectively and efficiently internally and externally.
· Complying with the organization’s Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.
EDUCATION OR TRAINING EQUIVALENT TO:
· Bachelor's Degree in Computer Science or Information Systems preferred or equivalent experience.
MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:
· 4+ years of experience utilizing various technologies in development and operation of EDI platform, interfaces and application integration solutions.
· Experience managing projects or heavy involvement in project implementation.
SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):
· In-depth knowledge of EDIFEC, Ultra Edits, SQL Server Integration Services (SSIS).
· Experience working with EDI files (834, 837) helpful.
· Knowledge in SQL Queries and Stored Procedure writing.
· Ability to resolve critical production issues.
· Ability to work in a creative, entrepreneurial environment and think outside the box
· Good problem solving and debugging skills