EDI Programmer

The position is responsible for driving the development and design of CenCal Health Health's EDI and operational data. Responsibilities include, but are not limited to:

• Maintain and develop Health Insurance Portability and Accountability Act (HIPAA) transactions.
• Design and development of solutions related EDI processes.
• Collaborate with other CenCal Health departments to assess and prioritize needs, and assist with developing strategies, plans, policies and procedures related to providing effective EDI solutions.
• Discover, explore, analyze and document data from all source and target systems to better understand the total scope of data availability at CenCal Health
• Recommend and execute modifications to EDI mappings and workflow in order to improve efficiency, reliability, and performance.
• Determines needs and capabilities of external customers to submit data electronically proactively identifies potential problems and defines user requirements, custom mappings, and user authorization protocols
• Promotes and further efforts to increase CenCal Health data quality and integrity; to ensure the quality and integrity of CenCal Health reporting through the implementation of standards based measures as defined by CenCal Health staff.
• Reviews existing EDI processes, procedures and systems to improve submission rate, reduce paper remits and improve the quality of each encounter with EDI Identifies best practices.
• Determines database structural requirements by analyzing client operations, applications, and programming, reviewing objectives with clients.
• Provides analysis, support and guidance to both internal and external critical customers on complex electronic data transfers covering enrollment, claims, billing statements and payments
• Initiates, communicates and coordinates all EDI activities with trading partners
• Recommending technical and procedural design for new or revised applications including flow charts
• Meets with CenCal Health customers and technical staff to determine information needs and requirement
• Implemented different types of Replication Models like Snapshot and Transactional.