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Senior Software Engineer

Job Title
Senior Software Engineer
Duration
Open until filled
Description

Job Title:  Senior Software Engineer

Duties:  Applies advanced knowledge of Edifecs Development Tools, Cognizant/Trizetto Facets, and the data architecture and the detailed analysis that Moda leverages based on those for many audits, including Content Management System (CMS) audits. 

Primary responsibilities include:

  • 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.

Additional Responsibilities:  
  • 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.  

Minimum Requirements:  Bachelor’s degree, or foreign academic equivalent, in Computer Science; and 6 years of experience as a Software Engineer or Developer, to include demonstrated experience in the following skills that may have been gained concurrently:  
  • 6 years in SQL Server development;
  • SQL development;
  • Edifecs Development Tools;
  • Cognizant/Trizetto Facets technologies; and
  • Data architecture.  


Job details:  The full-time position is at Moda Health Plan Inc., located at 601 SW 2nd Avenue, Portland OR 97204. This job may be performed remotely from unanticipated locations anywhere in Oregon, Washington, Alaska, Idaho, Arizona, Texas, or Florida.

Send resume to: Shawn Jones, Sr. HR Recruiter, Moda Health Plan Inc., 601 SW 2nd Avenue, Portland OR 97204; or by email at Shawn.jones@modahealth.com.