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The Senior Implementation Consultant assists in the testing and implementation of Edifecs’ solutions purchased by that client. The Implementation Consultant will generally be involved in installing & configuring under the direction of the Technical Project Manager and/or Implementation/Solution Architect. This includes installation of products on client hardware; configuration and development of programs, tasks and guidelines, and setup to fully implement an Edifecs solution. Duties can range from delivery of product training to new client specific requirements, development and deployment. The role involves client coordination and communication as well as technical understanding of Edifecs’ solutions and the transactions that flow through this position. 

Responsibilities

• Implement and configure Edifecs applications for payer systems on AWS, Azure cloud or virtual machines.
• Implement and manage integrations between Edifecs’ products and solutions and Customer’s on-premise systems.
• Analyze business requirements and translate them into technical configurations, workflows, and mapping documents.
• Develop and test real-time and batch integrations using:
• • EDI (X12: 834, 837, 835, 270/271, 276/277, 278)
  • FHIR (CMS Interoperability APIs)
  • HL7 v2/v3
• Implement service-based integrations via RESTful APIs, SOAP Web Services, ESBs, and iPaaS platforms.
• Create mapping specifications and perform data validation, reconciliation, and error resolution.
• Support ETL processes and legacy data migration to new payer systems.
• Perform data profiling, cleansing, transformation, and loading activities.
• Assist QA teams with creating technical test cases and validating system configurations and interfaces during SIT/UAT.
• Partner with business analysts, SMEs, solution architects and delivery leads to ensure alignment of technical deliverables.
• Develop appropriate training and development plans to meet the client's particular maintenance level and to configure the software according to the project plan.
• Provide post-implementation support during the transition from implementation to maintenance.
• Provide software and client specific training and develop training documentation based on present standards and client needs.
• Participate in design workshops, integration sessions, and go-live readiness planning.
• Provide technical guidance to junior implementation staff and contribute to solution documentation.

This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change.

Qualifications

• Bachelor’s in computer science, Information Technology, Information Systems or other technology related degree or equivalent experience in implementing, and operating Java stack-based enterprise applications.
• 5+ years of experience in technical healthcare system implementation, preferably with a payer or health plan.
• 3+ years of experience with Electronic Data Interchange (EDI) mapping and EDI analysis.
• Deep understanding of X12 standards, FHIR and other standards-based interoperability / integration patterns in the Healthcare Industry.
• Hands on experience in analyzing transactions and creating interfaces for transactions such as X12 837, 835, 834, proprietary formats and deep knowledge of coding standards such as LOINC, SNOMED, ICD 10.
• Familiarity with data formats: JSON, XML, HL7v2 messages, X12, flat files (CSV, pipe-delimited, etc.).
• Strong knowledge of Edifecs Applications.
• Decent knowledge of healthcare EDI transactions (834, 837, 835, 270/271, 278).
• Proficiency in data modeling (logical & physical) and relational databases (SQL Server, Oracle)
• Experience implementing solutions on AWS, Azure using CI/CD pipelines (GitLab, Jenkins, Terraform, CloudFormation).
• Experience working in Agile or SAFe environments.
• Working knowledge of java programming language and good understanding of SOAP and REST based webservices.
• Prior experience troubleshooting performance problems that may have many underlying causes such as Disk, Database, Network, Messaging and other platform / 3rd party solutions.
• Prior experience in troubleshooting problems in java based applications using opensource tools / JDK tools such as jstack, visualvm, jconsole, jmap and similar tools to identify memory issues, deadlocks, application performance.
• Experience using integration engines or tools (e.g., Mirth Connect, InterSystems, AWS Glue, Talend) is a plus.
• Expertise with healthcare data domains: member, claims, provider, enrollment, and clinical data.

Cognitive / Mental Requirements:

• Ability to work independently as well as collaborate as a team with a sense of urgency.
• Professional with the ability to properly handle confidential information.
• Be value-driven, understand that success is based on the impact of your work rather than its complexity or the level of effort.
• Ability to handle multiple tasks, prioritize, and meet deadlines.

Physical Requirements and Working Conditions:

• Flexibility to work with global teams as well as geographically dispersed US-based teams.
• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• Must be able to provide a dedicated, secure work area.
• Must be able to provide high-speed internet access/connectivity and office setup and maintenance.

Base compensation ranges from $100,000 to $145,000 per year. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs.

Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.

Cotiviti is an equal employment opportunity employer. Cotiviti recruits, hires and promotes individuals based on their qualifications for a specific job. Selection of employees is made without regard to race, color, creed, sex, age, religion, pregnancy or pregnancy-related conditions, national origin, sexual orientation, gender identity, marital status, genetic carrier status, military service, veteran status, uniformed service member status, disability, or any other category of class protected by federal, state or local laws. All employment decisions and personnel actions, such as hiring, promotion, compensation, benefits, and termination, are and will continue to be administered in accordance with, and to further the principle of, equal employment opportunity.
Pay Transparency Nondiscrimination Provision
Cotiviti will not discharge or in any manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-I.35(c)

Cotiviti is a leading solutions and analytics company that leverages unparalleled clinical and financial datasets to deliver deep insight into the performance of the healthcare system. These insights uncover new opportunities for healthcare organizations to collaborate to improve their financial performance, reduce inefficiency, and improve healthcare quality.

We focus on improving the financial and quality performance of our clients. In healthcare, this means taking in billions of clinical and financial data points, analyzing them, and then helping our clients discover ways they can improve efficiency and quality. In addition, we support retail and life/legal industries with data management and recovery audit services.

Cotiviti applies deep data science and market expertise to help healthcare organizations in three critical areas:

• Payment Accuracy: analyzing data flowing between payers and providers to ensure that claims are paid appropriately
• Risk Adjustment: ensuring that health plans accurately capture and report how sick their members are so that plans are appropriately reimbursed for the healthcare services their members receive
• Quality and Performance: evaluating healthcare cost, quality, and utilization at individual, provider, and population levels to identify the best opportunities for financial and clinical performance improvement