Systems Software Programmer

English Schedule Notes: Job Description attached (Please read) Work Schedule: Full time Hours Per Week: 35 Days: Monday, Tuesday, Wednesday, Thursday, Friday Shift time: 9am - 5pm Work location: Hybrid Patient Facing: No This position will ensure a successful migration to Health Edge / Health Rules Payer (HRP) core system for Provider Network Operations (PNO). This role will be part of cross functional and multi-departmental work groups, representing PNO, in the deployment of HRP, representing our priorities and workflows. Scope of Role & Responsibilities Support migration to a new core claim system (Health Rules Payer or HRP) for Provider Network Operations team (PNO) Attend all needed HRP meetings through a phased roll out by product which includes prep, testing and post go live meetings Maintain PNO issue tracker for HPR project for PNO Leadership Assist in HRP project issue resolution impacting Providers Assist in updating HRP or general PNO process documents, policies and/or desktop procedures for PNO as needed Prepare executive summaries and/or communication materials to convey HRP changes or updates Represent PNO VP or Director at HRP or other operational meetings as needed Work on other critical PNO projects as needed Assist in provider data quality assurance between CACTUS, Power Stepp, HRP and Salesforce through migration timeline and beyond as programs sunset. Monitor provider complaints related to HRP migration and prioritize for appropriate work groups and/or war rooms. Responsible for data collection, data extraction, data analysis, and data reporting activities related to HRP migrations and PNO issues Act as liaison between the Credentialing, Provider Maintenance, and Customer Service departments and investigate and respond to inter-departmental project-related inquires related to HRP or general PNO work as needed. Performs other support activites and duties as assigned Required Education, Training & Professional Experience

Requires a Bachelors degree; and 3-5 years experience in a healthplan; Medicaid plan a plus; or A satisfactory equivalent combination of education, training, and experience. Good understanding of provider network management and health system hierarchy set up at a health plan General understanding of provider network contract terms, Medicare fee schedules, CPT/HCPCs codes General understanding of claims adjudication at a high level; Health Edge/HRP experience a plus Good compend of Salesforce; experience at a health plan setting a plus Skills Required Cross Functional Coordination Experience with Salesforce and Provider Data Systems (CACTUS, Power step) Stakeholder Management Project Coordination & Operations Provider Network & Healthcare Knowledge Additional: Systems & Migration Support Preferred skills Systems Software Programmer

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