Job Description

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:

• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women

• Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR

• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.

• Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.

Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.

Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.

Skills / Requirements

JOB SUMMARY:
Provides technical services to analyze, design, and deliver clinical/business system and/or application solutions. Developing processes and procedures with in systems to support business stakeholders. Lends expertise to answer technical/application consulting questions, individually or as part of a project team. Serves as a subject matter expert associated with content, processes, and procedures associated with enterprise applications. Responsible for making recommendations regarding policies associated with the job¿s purpose and essential responsibilities.  Routine decisions include those regarding systems implementation and interaction with systems across Community Health Choice systems / applications.

General Responsibilities:

  • Provide technical consulting for project teams and emergency operational support for integration platforms and solutions as a subject matter expert.
  • Identify and execute optimization and efficiency initiatives to improve reliability and reduce cost of new and existing integration solutions across platforms including Informatica IICS, Mulesoft, Azure API Management, Azure Logic Apps, Azure Data Factory, GoAnywhere, Informatica, and Azure Synapse.
  • Develop sound solutions for integrations between on-prem and cloud solutions and determines the best methods for data transfer i.e. real-time, batch or pub-sub.
  • Determine ETL tools and architecture required to integrate On-Prem and Cloud Solutions i.e Informatica IICS, Azure Data Factory, Azure Functions and Azure Data Bricks.
  • Maintain the ability to bring the benefits of technology to solve complex business problems while managing cost and risk in a matrix environment.
  • Lead Report development using SSRS, Tableau and Power BI for monitoring and performance dashboards.
  • Write complex T-SQL queries to be used within Stored Procedures, Integrations and SSRS reports.
  • Develop and write complex mapping requirements and Data Flow diagrams for various Integrations between on-prem and cloud solutions i.e. SalesForce, Optum,  and Azure Cloud.
  • Perform system integration testing for conformance to functional and performance requirements to include Salesforce Real-Time integrations.
  • Perform data analysis, master data management (MDM), documentation, and verification of data types and supported data transport formats (flat-files, XML, JSON).
  • Utilize MDM for Member, Provider and Employee master data which would be used to send data to Salesforce and other downstream systems.
  • Develop timelines for project execution using Agile/Scrum methodology. (Product Owner)


MINIMUM QUALIFICATIONS:   

Education/Specialized Training/Licensure: Seven (7) years of experience analyzing, designing, support, development and/or delivering clinical/business solutions and/or Integartion experience across Cloud/Saas, and on premise systems  (a degree maybe offset experience requirement Bachelor degree = 4 years; Masters degree = 2 years)

Work Experience : Three (3) years of relational database management system (RDBMS) experience (with demonstrated knowledge of data
types, change control implications, and performance optimization).

Software Operated: Microsoft Office (Word, Excel, Access, Outlook)

SPECIAL REQUIREMENTS: 
1. Communication Skills:
Above Average Verbal (Heavy Public Contact)
Exceptional Verbal (e.g., Public Speaking)
Writing /Composing: Correspondence / Reports

2. Other Skills: Analytical, Medical Terminology, MS Word, MS Excel, and MS Access
3. Advanced Education:
Bachelor's Degree Major: Computer science, business administration, healthcare administration or other business or technology field.
Master's Degree Major: Computer science, business administration, healthcare administration or other business or technology field.

4. Work Schedule:   Flexible

5. Other Requirements: Knowledge:
Current business practices and computing systems and databases (SQL Server and MS Access). Understanding of Integration best practices to include Real-time and batch integrations. Proficiency in applying highly technical principals, demonstrated analytical, problem solving and research ability as evidenced by experience in the identification of business requirements and subsequent implementation of appropriate software configuration solutions to business problems.  Knowledge of health insurance payor systems and processes preferred.

Skills:
Requirements gathering, process mapping, group presentation, written and verbal communication, analytical, and or

Application Instructions

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