L.A. CARE HEALTH PLAN – $136,157.00/Year

Bachelors degree or foreign education equivalent in Computer Science, Information Technology, Business Administration or related field plus five 5 years of experience gathering business and technical requirements to develop a design and associated modeling for build work within healthcare environment or, alternatively, a Masters degree or foreign education equivalent in Computer Science, Information Technology, Business Administration or related field and three 3 years of experience gathering business and technical requirements to develop a design and associated modeling for build work within healthcare environment. Specific skillsother requirements Experience must include quantitative experience requirements not applicable to this section five 5 years of experience implementing systems to improve process automation, process flows, and accuracy in areas of Claims, Encounters, Risk Adjustment, and Payment Integrity within Health Plan environment; performing data and process design and modeling; performing systems and process automation; creating process flow and implementation to put the design into the various systems leading up to and including Production; designing, building and implementing custom solutions on the health care company platform on premises andor hosted by an outside company or vendor, including for web services; providing requirements analysis needed to develop and implement designs and systems changes relating to Medicare, MediCal, and Health Exchange and or Commercial Products; and, designing and implementing systems changes for Pre Pay and Post Pay Risk Adjustments through custom solutions on company platform to ensure correct party, member eligibility, contractual adherence, and Fraud, Waste and Abuse Detection and Prevention criteria are met.