HEDIS, NCQA

accreditation and Star ratings, and how application data supports them. CMS interoperability awareness an advantage. Correspondence — member and provider letter generation and the regulatory timing attached to it.

Platform experience:

Highly desirable — Cognizant CareAdvance (care and utilization management) and CareAdvance Provider / E-Referral (provider prior authorization portal) in a payer environment. Also relevant — TriZetto CareAdvance, Facets, QNXT, HealthEdge GuidingCare, ZeOmega Jiva, Altruista, or an equivalent in-house UM/CM system. Transactions and interfaces —

EDI X12 278

authorization request and response; 834, 837 and 835 useful. FHIR and clearinghouse integration such as Availity an advantage.

Technical skills:

SQL — confident writing queries against Oracle and SQL Server to validate requirements, trace a record and confirm a defect. A working requirement, not a nice-to-have. Data structures — able to read a data model and follow a field from source file through staging to the consuming application. Tooling — JIRA, Confluence or SharePoint, TOAD or SQL Developer. ETL concepts (Informatica or similar) and batch scheduling exposure useful. Testing — test case design, UAT coordination and defect triage. Postman or SOAP UI for web service validation an advantage.

Certifications:

IIBA CBAP or ECBA; PMI-PBA; CSPO. AHIP or AHM 250 payer certification desirable V2Soft is an Equal Opportunity Employer ( EOE). We welcome applicants from all backgrounds, including individuals with disabilities and veterans.

https:

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Functional Analyst for WCM