IT Manager of Data Management- Managed Care

AMAZING INDIVIDUALS WORKING FOR POSITIVE PEOPLE at AIDS Healthcare Foundation! Does the idea of doing something that really makes a difference in people’s lives while being well-compensated intrigue you? Are you looking to work for an organization that encourages growth and success from each and every one of its employees? If so, AIDS Healthcare Foundation is the place for you! Founded in 1987, AIDS Healthcare Foundation is the largest specialized provider of HIV/AIDS medical care in the nation. Our mission is to provide cutting edge medicine and advocacy, regardless of ability to pay. Through our healthcare centers, pharmacies, health plan, research and other activities, AHF provides access to the latest HIV treatments for all who need them. AHF is searching for an IT Manager of Data Management- Managed Care located in our Sunset Office. This opportunity is to work on a Full Time, Regular basis. The salary is based on experience, and we offer a competitive benefits package AHF’s core values are to be: • Patient-Centered • Value Employees • Respect for Diversity • Nimble • Fight for What’s Right STILL INTERESTED? Please continue! Essential Duties & Responsibilities Includes the following. Other duties may be assigned. Under general supervision of the IT Director Application Service Management, this individual plays a lead role with Database management, reporting, interpretation and analysis, and presentations, in support of various performance improvement efforts. The focus of this position is identification of Clinical, operational, and business improvement opportunities through functioning as an analyst, facilitator, consultant, and/or project manager as required within our clinical and Managed Care operations performance improvement initiatives. Supervise members of Managed Care data team monitoring timely submission of designated contractual/regulatory reporting for all Managed Care contracts including Medicare, Medicaid, and Disease Management contracts. Conduct in-depth analysis of Managed Care data and ensure that the reports are created and generated accurately in a timely manner for review, analysis and subsequent submission to the customers Serve as a thought leader by providing creative database solutions to meet business needs and evaluate efficiency of existing database operations and provide recommendations for improvement as necessary. Manage technical implementation and deadlines across multiple Claims projects and collaborate effectively with Application Team and project managers to implement project deliverables. Manage end-to-end ETL for the processing of data files including pulling and pushing data files from external partners, data cleansing, data analysis, data conversion and reporting for the following partners. Medicare, Medicaid, DM contracts, and PBM. Access multiple medical/financial/administrative databases and provide ongoing reporting that supports information-based decision making, measures the execution of strategy, and identifies opportunities for improving existing processes. Establish new or modified reporting methods and procedures to improve report content and completeness of information and be the Primary contact for all Medicare and Medicaid data reporting and analytic requirements. Development of Custom reporting solutions using SQL Server Analysis Services and prepares various reports required by funding sources, fiscal intermediaries, medical staff, and management on a routine and ad hoc basis. Create and maintain data correction logs that identify the date the correction that was performed, tables and fields effected, submission effected, error code effected, and other pertinent metadata. Works regularly with management, physicians, consultants, other AHF and IT staffs to determine, interpret and program solutions. Pursue ways to improve overall data quality and efficiency. Monitor all data entry points to ensure consistency across the organization. Supervises the data submission and reporting portion of enrollment/invoicing process by maintaining the appropriate data sources and analyzes the data for accuracy. Provide support for Managed Care audits including supervising data extractions and validating selection coding. Prioritize assignments while working on multiple issues, projects and support requests and work well with multiple lines of businesses and other support areas and shift priorities as required meeting business requirements and deadlines Collaborate with Internal and External customers to define and document the scope and functional requirements for data and reporting needs. Work with Off Shore Team for the production support, Production and/or Test server upgrades. Implementing new EDI instances and programs to support the intake and creation of EDI files and integrating the data with AHF’S existing business systems. On boards the project design of all EDI transactions; Manages, tests and implements data trading relationships with outside vendor, carrier or other business. Tracks and reports EDI production accuracy. Identifies, analyzes and devises solutions for business and technical EDI data problems. Responsible for complex systems process analysis and design, including analysis of X12 requirements. Perform exploratory data analyses and present findings to both technical and non technical audiences. EDI Mapping knowledge to create custom mapping for CMS AHCA DHCS 5010 File Format. knowledge of the HIPAA transactions using the X12 5010 formats and D.0 Strong Knowledge of transaction set requirements: 204, 214, 180, 810, 880, 856, 850, 875, 861, 855, 856, 945, 947, 888, 940 and 997 Work with Operations and Practice Management system vendor to maintain an electronic benefits verification system Participation in AHF Meetings/Committees Attends AHF meetings as assigned. Supervisory Responsibilities Supervises data analyst responsible for reporting and maintaining Managed Care data files, reports and the applications. Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Strong understanding of software development life cycle (SDLC), source control and change/release management procedures is required, practical experience in building change/release management scripts is highly desirable Extensive experience developing with Microsoft SQL Server 2005 or 2008 R2 product stack Strong T-SQL and Integration Services skills MS Analysis Services and Reporting Services skills a plus Thorough understanding of dimensional and relational modeling practices In-depth experience constructing databases Performance tuning and troubleshooting complex database processes Hands-on experience with C#, VB.NET, and XML Education and/or Experience Bachelor's Degree (BA) or higher in Computer Science or related disciplines; a minimum of 4 years’ experience including 2 or more years in Healthcare Services - Medical Records, Health IT or Informatics; Managed Care experience preferred; Or equivalent combination of education and experience. Computer/Software Skills & Abilities To perform this job successfully, an individual should have knowledge of Database related software (SQL 2000 or SQL 2005, MS Access Data Project); Internet software; Spreadsheet software, and Word Processing software If you are interested in this amazing opportunity, please CLICK HERE for immediate consideration. AHF IS AN EQUAL OPPORTUNITY EMPLOYER

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