Data Engineer (claims)

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

The position of Data Engineer in the Analytics and Reporting Department is responsible in managing encounter data submission to NYSDOH, CMS and other regulatory entities as required.  The responsibility includes troubleshooting EDI mapping issues, Encounter data reporting errors, monitoring Encounter Data Quality reports, ensuring adherence to EDI standards, writing complex SQL Queries and stored procedures, SSIS jobs for EDI file submission, and troubleshooting EDI error records. Additionally, this role is responsible for developing and maintaining EDI documentation including process flow and cross-functional team collaboration regarding identification of EDI problem areas. Lastly, the Data Engineer is responsible for preparing test data, conditions and expected results to verify new EDI updates and logic.

The successful candidate must have strong SQL programming skills, working EDI Analytical skills, communication skills, and healthcare experience with knowledge in membership, provider, and claims data.  
 

• Monitor and submit Encounter Data files to NYSDOH OSDS and CMS.
• Collaborate with vendors/end users on correcting EDI error transactions and resubmissions to NYSDOH and CMS.
• Automate manual processes for Encounter Data submissions.
• Support the Compliance and Regulatory department for any inquiry on Encounter Data processes.
• Support MMCOR reporting
• Create KPI reports on Encounter Data reporting.
• Create SQL stored procedures and flow diagrams and document the process for Encounter Data Reporting.
• Troubleshoot EDI Errors and keep track of all the resubmissions.
   

• Bachelor's degree in information systems, Computer Science, Database Management, or related field.
• Minimum 5 years of programming experience in SQL Server database object development including but not limited to stored procedures, functions, views, SSIS and SSRS, X12 EDI mapping and development, and troubleshooting EDI errors.
• Minimum 3 years' experience in complex healthcare data like Claims and Enrollment.
• Working knowledge of EDI X12 standards
• Previous experience in BI reporting tools, such as BusinessObjects, Tableau, or Power BI
• Knowledge of Visual Studio, .NET Development, XML, BizTalk. 

Professional Competencies 

• Integrity and Trust 
• Collaboration and time management skills 
• Functional/technical skills 
• Written/oral communication 
• Ability to work effectively in a team environment and adapt to different projects and assignments quickly.
• Excellent analytical and problem-solving skills

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