The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
This position is remote eligible; Candidates MUST reside in California.
What You Will Be Doing:
Under general supervision, responsible for establishing and maintaining documentation related to current claims billing practices, and provider relationships in collaboration with Provider Services.
Essential Functions
- Provides claims data QA oversight.
- Examines complex data to optimize the efficiency and quality of the data being collected.
- Develops data quality metrics and standards for different types of data to ensure that it is high quality and error-free.
- Develops data quality models to identify issues with the data and recommend solutions to improve the data quality.
- Conducts and tracks routine audits on data collection/reports and reports results to claims leadership.
- Collaborates with database developers and Claims Data Analyst to improve systems and data scripts.
- Researches and recommends new testing tools and test strategies from internal and external sources.
Non-Essential Functions
What You Bring:
Knowledge, Skills, Abilities and Competencies
- In-depth knowledge of analytics principles, concepts, best practices, and performance measures, with the ability to effectively use, implement and maintain them.
- In-depth knowledge of data sets, claims data structures and data warehousing, claims payment systems, metrics, processes, policies, and procedures.
- Strong oral and written communication skills with the ability to communicate professionally to diverse individuals, effectively explain or interpret information, and conduct presentations.
- Knowledge of the Agile development methodology
- Knowledge of .net, SQL Server, Python, JAVA, SSIS, Excel and SSRS.
- In-depth knowledge of SQL, ability to construct moderately complex SQL queries.
- Strong knowledge of quality assurance processes and standards, including the development and use of test metrics.
- Strong knowledge of audit processes, and the ability to effectively implement and maintain them.
- Good leadership skills, with the ability to establish direction, build alliances and influence others.
- Strong customer service skills and service orientation.
- Strong collaboration skills.
- Good facilitation and conflict resolution skills.
- Ability to work independently and as part of a team.
- Basic mathematics skills.
- Ability to speak and be understood in English.
- Ability to handle confidential information with appropriate discretion.
What You Have:
Education and Experience
- Bachelor’s degree in computer science or related discipline; and
- At least three years of relevant QA experience; or
- Equivalent combination of education and experience.
Preferred:
- Experience in Medi-Cal or Managed Care Environment
Licenses, Certifications
Preferred:
- Quality Assurance Certification and Certified Scrum Master
What You Will Get:
HPSJ Perks:
- Competitive salary
- Robust and affordable health/dental/vision with choices in providers
- Generous paid time off (starting at 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays)
- CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan
- Two flexible spending accounts (FSAs)
- Employer-Paid Term Life and AD&D Insurance
- Employer-Paid Disability Insurance
- Employer-Paid Life Assistance Program
- Health Advocacy
- Supplemental medical, legal, identity theft protection
- Access to exclusive discount mall
- Education and training reimbursement in addition to employer-paid elective learning courses.
- A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do.
- A shorter commute – if you’re commuting from the Central Valley to the Bay Area.
- Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects.
We are an equal opportunity employer and diversity is one of our core values. We believe that differences including race, ethnicity, gender, sexual orientation, and other characteristics, will help us create a strong organization that is sensitive to the needs of those we serve. Employment decisions are made on the basis of qualifications and merit.
HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation or any other characteristic made unlawful by applicable Federal, State or local laws. It also prohibits unlawful discrimination based on the perception that anyone has these characteristics or is associated with anyone who has or is perceived to have these characteristics.
Important Notice: This job description is not a contract between HPSJ and the employee performing the job. The duties listed in the job description may be changed at the discretion of HPSJ, and HPSJ may request the employee to perform duties that are not listed on the job description.
