Systems Software Programmer / Business Process Specialist

This position supports the successful migration to the Health Edge / Health Rules Payer (HRP) core system for Provider Network Operations (PNO). The role participates in cross-functional and multi-departmental workgroups, representing PNO priorities and workflows throughout system deployment., * Support migration to Health Rules Payer (HRP) core claims system for Provider Network Operations

• Participate in all phases of HRP rollout including preparation, testing, and post go-live activities
• Maintain PNO issue tracker and support issue resolution impacting providers
• Update process documentation, policies, and procedures related to HRP and PNO operations
• Prepare executive summaries and communication materials related to HRP updates
• Represent PNO leadership in operational and HRP-related meetings
• Support additional critical PNO projects as needed
• Perform provider data quality assurance across CACTUS, PowerStepp, HRP, and Salesforce systems
• Monitor and triage provider complaints related to HRP migration
• Perform data collection, extraction, analysis, and reporting related to HRP migration and PNO operations
• Act as liaison between Credentialing, Provider Maintenance, and Customer Service teams
• Investigate and respond to interdepartmental inquiries related to HRP and PNO processes
• Perform additional duties as assigned

• Cross-functional coordination and stakeholder management
• Project coordination and operational support
• Experience with provider data systems (CACTUS, PowerStepp, Salesforce)
• Experience supporting system migrations (HRP/HealthEdge preferred)
• Strong analytical skills including data collection, extraction, and reporting
• Knowledge of provider network operations and healthcare systems
• Understanding of provider hierarchy, contracts, Medicare fee schedules, CPT/HCPCS codes
• General understanding of claims adjudication processes
• Ability to manage multiple priorities and meet deadlines
• Strong written and verbal communication skills
• Ability to work independently and in a fast-paced environment
• Strong proficiency in Microsoft Office tools, * Bachelor's degree required
• 3-5 years of experience in a health plan environment (Medicaid experience preferred)
• Equivalent combination of education and experience accepted, * Integrity and Trust
• Customer Focus
• Detail-oriented, organized, and dependable
• Strong problem-solving and analytical abilities
• Ability to manage workload independently and escalate issues appropriately
• Ability to prepare reports and deliver presentations
• Ability to interpret data and provide actionable recommendations
• Ability to prioritize and work in a dynamic environment