Edi Application Development Engineer (Senior Professional Programmer Analyst)

Job Summary

Expert in at least one EDI & QNXT Data component, X12 transaction set, an implementation manager, or a support manager.  From a solution standpoint, independently represents at least one EDI & QNXT Data component through all phases of the system development life cycle.  Represents these solutions to customers, designing customized instances and implementing these solutions.  Leads a group of 1-5 resources through an EDI & QNXT Data implementation or through ongoing support of an existing customer site.  Demonstrates both technical and business prowess in the solution set they represent.  Continues to increase their technical expertise across all EDI & QNXT Data components, into Integrated Solutions areas, and into other CEF groups to aid in integration efforts.  Also continues to increase their management skills through experience and additional training and education.  Expert in the field of EDI Healthcare transaction sets.

Essential Functions

• Duties and Responsibilities (List all essential duties and responsibilities in order of importance)
  o Analyzes, models, designs, develops and implements EDI & QNXT Data components and X12 Transaction Sets for Medicaid sites.
  o Designs, develops and implements customized functionality to accommodate business processes related to EDI & QNXT Data components.
  o Identifies the need for and develop new EDI & QNXT Data functionality to accommodate new business processes and procedures as they are introduced to the solution.
  o Assists and mentors peers with understanding EDI & QNXT Data components, technical architecture, custom development, and operations support.
  o Assists all other CEF groups involved in integration efforts across the practice that involve EDI & QNXT Data.
  o Identifies and prescribes technical solution requirements in support of the CEF Business Development group’s efforts in writing proposals and responding to RFPs and RFIs, etc.
  o Represents the EDI and QNXT Data group as a new implementation lead or existing customer support lead, managing junior Integrated Solutions resources.
  NON-ESSENTIAL FUNCTIONS
  List other duties which are of secondary importance and marginal to the position’s purpose.
  • Other duties as assigned.

Knowledge/Skills/Abilities In depth knowledge of HIPAA/EDI X12 4010/5010 healthcare-related transactions including 270-271, 276-277, 278, 820, 834, 835, 837, 997, 999, 824, and NCPDP 5.1 & D.0
o Knowledge of EDI applications including the EDI Gateway, Edifecs suite of tools, Microsoft Biztalk, Microsoft SQL Server, and other applications in support of EDI processing
o Knowledge of QNXT Administrator and QNXT Connect
o Fluent with commonly used EDI concepts, practices and procedures within a heath care field
o Medicaid domain knowledge
o Expert knowledge of industry standard health data code sets such as ICD-9/ICD-10, CPT/HCPCS, revenue codes
o Knowledgeable with regulatory requirements associated with 5010 and ICD-10
o Specific knowledge of claims, enrollment, and /or Authorizations in a Medicaid environment
o Possesses analytical and creative problem solving skills
o Excellent verbal and written communication skills
o Ability to abide by Molina’s policies
o Ability to maintain attendance to support required quality and quantity of work
o Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
o Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers

Required Education: 
Bachelor’s Degree or equivalent experience 

Required Experience: 
Combined 5-10 years of health care, EDI, and project management experience.         

Required Licensure/Certification:
N/A                            

Preferred Education:
Bachelors Degree in Computer Science or related field

Preferred Experience:
5-10 years of Medicaid, CEF solution sets, and project management experience.

Preferred Licensure/Certification:
PMP