Job ID# 10SC1 – Posted 4/07/2023 – San Jose, CA

Candidate will provide direct Epic application support and Epic software development lifecycle for the design, development, monitoring, testing, updating, integration, and maintenance of system stabilization.

Candidate will analyze user, system, and application needs and will evaluate approaches to determine the best solution to meet VHP’s business needs via performance of the defined itemization of responsibilities above and below.

• Experience in business analysis and project management.
• Knowledge of healthcare and health insurance regulatory standards.
• Epic implementation experience specifically at a health plan.
• Understanding relationships of providers and their processes in the healthcare continuum (primary care, specialists, lab ordering, surgery).
• Familiarity with case management workflows and wellness programs. Familiarity with or background in quality reporting initiatives such as PQRS, ACOs/MSSP, and MU.
• Familiarity with health plan concepts and workflows.
• Understanding of operations within the AP Claims department, including claim intake, review, and payment.
• Familiarity with integration points with other areas of business, such as eligibility, authorizations, and internal claims.
• Familiarity with the benefit structures of plans.
• Familiarity with the use of care plans to coordinate care for members/patients.
• Familiarity with managed care contracting.
• Understanding of treatment authorization polices/processes that affect approvals or denials and the concepts of treatment referrals and the processes followed.

A minimum of 1 year of application support/build/configuration and/or related business/operational experience in a health plan or health care setting.

This classification requires the possession of a bachelor’s degree in an IT-related or Engineering field.

CERTIFICTATION/TRAINING

– Health Planet Analytics and Clinical Build
– Epic Care Link

Please send your resume and any additional information to our recruitment team at recruitment@nexlogica.com