The Health Plans Developer – Operations Support reports to the Director of IM, in the Information Management (IM) department, is primarily responsible for activities related to supporting scheduled jobs and other technical tools within the department. To also provide as the primary role to handle first level Incidents and problem request. A secondary responsibility would be translating business requirements to design and then into working code that handles custom data formats, workflows, and rules as it relates to key Health Plan technology systems. Specifically, the position works closely with CHRISTUS Health Plan management, application users, and other IM teams as it relates to data integration, technical process documentation, business requirements analysis. This position provides Incident, Problem Request, and Code/Change management supporting and following ITIL best practices. This role requires to collaborate and work with another team member with a focus on quality support to both internal and external users with a focus on customer services and timeliness.
Follows the outlined Service Management Processes including issue/request SLA and SEV1 and two application outages.
Responsible for thorough documentation within the call tracking database and knowledge database to document workaround or resolution of frequent incidents to enhance the quality of problem resolutions for future incidents.
Develop transformations and code using ETL tools (preferably SSIS).
Coordinates code changes with appropriate vendor related to financial and business application issues.
Collaborates with various IM teams to identify and infrastructure related issues that have resulted in application issues.
Aggressively manages workload related to open issues and service requests to ensure agreed upon SLA's are met.
Provides/coordinates resolution of issues while recommending procedures and controls for problem prevention, escalation, etc.
Follows the outlined Service Management Processes including Incident, Change, Problem, Request management.
Provides thorough documentation within the call tracking database and a knowledge database to document workaround or resolution of frequent incidents to enhance the quality of problem resolutions for future incidents.
Develop extensions within the Health Plan application using XSLT and XLT.
Plans, analyzes, researches, designs, codes, deploys, tests software applications in SQL Server, .NET, SSIS, SSRS, XSLT, and crystal reports
Develops reports and extracts as per specifications and requirements
Analyzes business requirements and documents functional requirements
Prepares technical design documents
Guides and assists development team in deciding best approaches and practices
Participate in peer review and unit testing of applications
Provides Tier III support and maintenance of all Health Plan applications
Works with the business and the IM team regarding application configuration changes and system upgrades
Provides guidance to end users during user acceptance testing
Prepares a weekly status report for tasks assigned
Works with the end user to discuss on solutions, concerns, and suggestions
Demonstrates strong communication and human relationship skills.
Provides effective customer service by being courteous, polite and friendly at all times.
Acknowledge customers timely to determine their need and help the customer resolve the issue or request.
Participate in departmental programs that promote and deliver exceptional customer service.
Performs other duties and special projects as requested
Pursue professional growth and development through personal reading, seminars, workshops and professional affiliations to keep abreast of the trends in his/her field of expertise.
May be required to travel to perform duties.
Rotate as an on-call developer to support the department.
May be required to work outside of normal working hours.
May be required to work long hours during critical problems or implementations.
Perform other duties as requested by management within the IM Health Plan department
Bachelor's Degree in Computer Science or combined equivalent experience.
3+ years of recent experience in C# .net, Stored Procedures, User Defined Functions, Views, using SQL, ETL (SSIS preferred), SSRS and Crystal Reports
Working knowledge in Python, PowerShell, XML, XSLT, REST, WCF, .NET, and batch commands
Working knowledge of the Affordable Care Act/Health Insurance Exchange Medicaid, Medicare, and Commercial Health Plans
Functional expertise in enrollment processing, claims processing, provider contracting and pricing, EDI (HIPAA Transactions) processing, integration
Advanced skills with Health Insurance Claims Processing Systems.
Knowledge of EDI Healthcare Transactions (820, 270, 271, 834, 837, 270, 271 etc...)
Strong technical experience in EDI Mapping tools, Trading Partner Configuration, Databases (SQL Server), Reporting, Sharepoint, Microsoft Office Suite - Excel, Access, PowerPoint, etc.
Knowledge of industry standard health data and code sets such as ICD-10, CPT/HCPCS, Revenue codes, 5010, NCPDP Eligibility / Enrollment Data Model & Structure, Member/Eligibility Input & Output Feeds
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.