Senior Software Engineer - Portland, OR
Moda Health
- Portland, OR
- Permanent
- Full-time
- Create new SQL objects (store procedures, functions, tables, and indexes) and TSQL scripts.
- Provide 24/7 Support for Edifecs implementation of Smart trading platform, operating rules and FHIR systems.
- Design and implement new Edifecs maps and profiles to load data formats proprietary to the health care industry including HIPAA X12 834, 835, 837, 270/271, 276/277, 277CA, EDI formations.
- Support and maintain X12 EDI transaction processing solutions for 834, 835, 837, 277CA and real-time 270's.
- Create custom ETL processes for loading vendor-provided files (excel, csv, and flat) using C#, SSIS, and other tools.
- Create outbound ETL processes to generate custom files (excel, csv and flat) for vendors using C#, SSIS, and other scripting languages.
- Create custom solutions for data exchange between the Health Plan and the Centers for Medicare and Medicaid Services.
- Create and maintain custom solutions for the CMS Enrollee-Level External Data Gathering Environment (EDGE).
- Create and maintain custom solutions for CMS Interoperability and FHIR systems utilizing Edifecs.
- Analysis, estimate, design and lead cross-functional development efforts for new projects.
- Understand Facets data structure (membership, claim, provider & billing system) and provide impact analysis.
- Develop and maintain the real-time accumulator share processing with the Pharmacy Benefit Management vendor utilizing Edifecs to exchange the NCPDP benefit data structure via custom RESTful API solutions.
- Monitor, maintain, and expand the core Facets batch and data exchange process for claim adjudication, billing, payment/invoicing, and eligibility transactions.
- Create and maintain batch jobs using Tidal Enterprise Schedule ensuring jobs are exclusive and include proper inter-job dependencies as required.
- Mentor team members in data modeling, coding best practices, data integrity, troubleshooting, issue management, etc.
- Ensure company policies and standards are maintained across daily and project work.
- On Call 24/7 Support and Coordination with Edifecs Vendor and internal support teams to resolve Edifecs system failures, apply custom Moda code, and Edifecs supplied patches to all environments.
- Work with EDI team to fix file processing errors in Edifecs system.
- Troubleshoot Core System Facets claims processing issues.
- For audits, provide reports and data as requested with quick turnaround time.
- Support Oregon/Alaska CMS health insurance exchange audits.
- Identify and correct SQL server performance and deadlocks issues in production and test environments. Includes training other team members on proper performance tuning.
- Use Azure DevOps for code management, change management, and code deployments.
- 6 years in SQL Server development;
- SQL development;
- Edifecs Development Tools;
- Cognizant/Trizetto Facets technologies; and
- Data architecture.