This is a 100% CAREER position with the UC Davis Health System, Department of Information Technology located in SACRAMENTO, CA.
Working hours are M-F, 8-5.
This position is not represented by a union.
OPEN UNTIL FILLED. INTERVIEWS MAY BE HELD AFTER 4/1/15.
THIS IS NOT AN H-1B OPPORTUNITY.
This role will provide leadership, project management and other assigned duties relating to the Clinical Information Systems applications, specifically Epic Tapestry. Responsibilities include: designing, developing, testing and implementing all facets of Tapestry which includes Utilization and Case Management, AP Claims, Benefits, Contracts, Capitation and Eligibility. The incumbent will also manage planning, development, testing and training of custom application functionality. This role will work with cross-functional teams and end users along with Senior and Executive Stakeholders to ensure appropriate workflow development, testing and training of application functionality.
–Expert knowledge of SDLC and utilization of project management tools and methodologies with proven competency in managed care operations.
–Excellent understanding of managed care areas of the healthcare business including Utilization Management, Case Management, AP Claims, Contracts, Benefits, Capitation and Eligibility.
–Experience with electronic AP Claims and Remittance functionality and/or knowledge of industry standard EDI transactions (837, 277, and 835) required.
–Understanding of Utilization Management processes in a delegated model including authorizations, denials, appeals and regulatory compliance.
–Familiar with CPT codes, diagnosis codes, payment methods including fee schedules, RBRVS, DRGs that support AP Claim payments.
–Good understanding of HMO health plan benefits including capitation, carve outs, maximum out-of-pocket expenses, copays, co-insurance, coordination of benefits and familiarity with non-HMO products.
–Excellent analytical and problem-solving skills.
–Excellent communications skills, both verbal and written.
–Previous experience with re-engineering and process improvement techniques.
–Good working knowledge and previous experience with business systems, PCs, collaborative computing tools, information management in healthcare, general information architectures, systems integration, laws, and regulations.
–Certification in Tapestry, Benefits Engine and/or AP Claims preferred.
–Benefits Engine, Vendor Contracts and Fee Schedules build experience preferred.
–Academic institution or large integrated health system experience preferred.
–Knowledge of Lean Sis Sigma/DMAIC methodologies preferred.
Must be able to pass Epic certification exams in two attempts, within three months.
Must be able to travel to Wisconsin to attend Epic certification training sessions.
Must be able to work flexible hours, as needed, to meet committed project dates.
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