HJ Staffing

• Lead the end-to-end planning, execution, governance, and delivery of all claims-related implementation activities • Collaborate closely with product managers and leaders supporting Provider Data, Configuration (provider contracts, benefits, utilization management, business rules), and Capitation to ensure a seamless migration, precise claims adjudication, and operational readiness for go-live • Accountable for end-to-end implementation and issue resolution for the QNXT Claims workstream, driving the complete migration off the IKA platform • Manage the claims implementation plan across operations, configuration, testing, data conversion, training, cutover, and post-go-live stabilization • Maintain RAID logs, decision logs, and status reporting • Coordinate alignment across Claims, Provider Data, Benefits, Utilization Management, and Capitation to ensure accurate future-state claims adjudication, pricing, and payment • Direct day-to-day collaboration with external implementation consultants and software vendors to ensure scope, timelines, deliverables, and architecture decisions stay on track • Lead preparations for system testing, defect triage, mock conversions, go-live cutover, and post-implementation stabilization while validating contingency and readiness plans • Proactively identify execution risks, workflow gaps, and dependency issues to safeguard project timelines, claims accuracy, and stakeholder confidence

• Conduct timely medical necessity determinations for inpatient admissions, continued stays, and post-acute care settings for Commercial and Medicare Advantage populations • Apply nationally recognized guidelines to ensure appropriate level-of-care determinations • Serve as the lead physician reviewer for complex, high-risk, or potentially adverse UM cases requiring clinical judgment • Conduct peer-to-peer discussions with attending and treating physicians to clarify documentation, discuss options, and align on appropriate care plans • Partner with Care Management and UM teams to identify utilization trends, reduce avoidable readmissions/extended stays, and streamline care transitions • Offer clinical expertise to support quality improvement initiatives, regulatory audit preparedness, policy development, and UM committee activities • Maintain precise, compliant, and timely documentation of all reviews and rationales in accordance with federal, state, and organizational guidelines.

• Lead the assessment and implementation of the PeopleSoft Person Model, specifically focusing on Person of Interest (POI) and Hire/Rehire workflows • Design and maintain solutions using the full PeopleTools suite (Application Designer, Application Engine, PeopleCode, and Component Interface) • Review, modify, and support COBOL programs tied to HCM batch processes • Build and optimize integrations between PeopleSoft and external systems, including Identity Management, payroll vendors, and onboarding tools • Evaluate current configurations to recommend scalable implementation approaches and ensure data integrity through expert-level knowledge of effective dating logic • Create high-quality technical documentation and provide hands-on training to internal teams to ensure long-term system sustainability

Role Description HJ Staffing is seeking a qualified, detail-oriented Contract Analyst for a temporary assignment supporting our Contract Administration team at a higher education institution in Houston, TX. This initial engagement is anticipated to last approximately one month, with a strong possibility of extension based on project needs and workload. Whether you are a Houston local looking for a hybrid campus role or a virtual professional seeking a remote opportunity, we welcome your application! As a Contract Analyst, you will ensure the integrity, organization, and compliance of our contract ecosystem. Your primary duties will include: - Review & Audit: Thoroughly examine contract files and related documentation to ensure accuracy and compliance. - File Validation: Verify and validate file completeness, identifying and resolving any missing documentation. - Record Management: Organize, update, and maintain physical and digital contract records for easy retrieval. - Compliance Support: Assist with compliance reviews and ensure alignment with institutional policies and procurement regulations. - Administrative Support: Provide general operational support to the Contract Administration team to keep projects moving forward. Qualifications - Mid-level experience specifically within procurement contract administration. - Prior experience working within a higher education (college/university) environment is highly preferred. - Exceptional organizational skills, laser-focused attention to detail, and a strong understanding of contract lifecycles and compliance. - Proficient with contract management software, digital filing systems, and standard office productivity tools (MS Office, Google Workspace). - Open to local candidates in Houston, TX, as well as 100% virtual/remote candidates across the US. Requirements - Experience in procurement contract administration. - Industry knowledge in higher education. - Strong organizational skills and attention to detail. - Proficiency in contract management software and office productivity tools. Benefits - Competitive pay rate dependent on experience.

• Ensure the integrity, organization, and compliance of our contract ecosystem. • Thoroughly examine contract files and related documentation to ensure accuracy and compliance. • Verify and validate file completeness, identifying and resolving any missing documentation. • Organize, update, and maintain physical and digital contract records for easy retrieval. • Assist with compliance reviews and ensure alignment with institutional policies and procurement regulations. • Provide general operational support to the Contract Administration team to keep projects moving forward.

• Lead the assessment and implementation of the PeopleSoft Person Model • Design and maintain solutions using the full PeopleTools suite • Review, modify, and support COBOL programs tied to HCM batch processes • Build and optimize integrations between PeopleSoft and external systems • Evaluate current configurations to recommend scalable implementation approaches • Create high-quality technical documentation and provide hands-on training to internal teams

We are looking for a Jiva Application Analyst II to join our Application Services team. Candidate MUST have 3-5 years working with Jiva Care Management platform. As an Analyst II, you are at the "full working level" of our series. You’ll handle medium-level product configuration tasks that require a deep dive into business and system expertise. You’ll sit right in the sweet spot of our department—more advanced than our entry-level roles, while collaborating closely with our senior analysts on high-level system architecture and tactical plan projects. What You Will Do - System Optimization: Perform troubleshooting and resolve issues for core systems, internal developments, and vendor integrations. - Configuration & Testing: Assist in designing, testing, and documenting configuration solutions and evaluating departmental workflows for better efficiency. - Project Support: Participate in the full software lifecycle, from defining project scope and gathering requirements to implementing tactical plan projects. - Regulatory Alignment: Help interpret policy changes from DHCS, DMHC, and CMS to ensure our systems remain compliant. - Reporting: Generate operational and system reports to keep leadership informed on system health and performance. - Training & Mentorship: Act as a technical resource for staff, developing training materials and facilitating sessions to ensure the team is proficient in our core systems. What You Will Bring - Education: Bachelor’s degree in Business, IT, Health Care, or a related field. (A Master’s degree plus 1 year of experience also qualifies). - Jiva Expertise: 3–5 years of hands-on experience with the Jiva Care Management platform is strictly required. - Industry Experience: A minimum of 3 years of product configuration or business systems analysis experience within a managed health care environment. - Technical Savvy: Proficiency in SharePoint, MS Office (Excel, Visio, etc.), and a solid understanding of the software product lifecycle (SDLC). - Domain Knowledge: Familiarity with Medicaid/Medicare, national diagnostic coding, and regulatory policies (Medi-Cal experience is a plus). - Agile Mindset: Some knowledge of Agile/Scrum environments and Application Lifecycle Management methodologies. You Will Be Successful If... - You can translate complex business needs into detailed product requirements. - You are a problem-solver who knows when to handle an issue and when to escalate. - You enjoy collaborating with a diverse range of stakeholders, from technical devs to clinical staff. - You are organized enough to manage multiple projects simultaneously without breaking a sweat. - You have a knack for training others and can adjust your communication style for any audience. Additional Details - Remote Work: This position is 100% remote. - Schedule: Monday through Friday, 8:00 AM to 5:00 PM Pacific Time (PT). Candidates must be comfortable working these specific hours regardless of their local time zone.

We are seeking a detail-oriented OpenText Exstream Developer to join our team on a part-time basis. In this role, you will be the technical steward of our member and provider communications. Your mission is to ensure that critical documents—from ID cards to EOBs—are accurate, compliant, and delivered seamlessly. This position is 100% remote. You will focus on maintaining and enhancing our template library while ensuring tight integration with the HealthRules Connector. If you enjoy the intersection of complex data mapping and high-stakes healthcare compliance, we want to hear from you. What You Will Do - Template Mastery: Maintain and enhance OpenText Exstream templates for core health plan correspondence, including EOBs, EOPs, ID cards, COBRA notices, and welcome letters. - System Integration: Integrate Exstream with the HealthRules Connector Correspondence module, managing both XML and flat-file data feeds. - Production Support: Rapidly troubleshoot production defects and resolve member communication issues to ensure zero downtime in correspondence delivery. - Regulatory & Branding Updates: Implement essential updates driven by evolving state/federal regulations or brand refreshes. What You Will Bring - Experience: 3+ years of dedicated OpenText Exstream development specifically within the health plan or insurance sectors. - Technical Knowledge: Proven experience integrating Exstream with Core Administrative Processing Systems (CAPS), specifically HealthRules Payer. - Data Expertise: Proficiency in XML and flat-file data mapping and transformation. - Domain Expertise: Deep familiarity with commercial health plan document types (ID cards, group statements, regulatory notices, etc.). - Compliance Awareness: A solid understanding of health plan regulatory requirements (e.g., ERISA, state insurance codes) is highly preferred. - Channel Versatility: Experience with multi-channel delivery (print, email, and member portals) is a plus. Part Time role - must be willing to work PST hours, must have health plan experience This position is 100% remote.

HJ Staffing is seeking a Director of Claims and Encounters to provide strategic leadership, fiscal accountability, and operational excellence. This executive role is responsible for directing Claims Operations for Commercial/ASO, Medicare, and Medicaid products. You will lead the Encounters Resolution team to ensure completeness and maximize Medicaid rate setting, driving operational strategy through accurate, timely, and efficient delivery. What You Will Do - Strategic Leadership: Translate strategic goals into specific operating and resource plans. Drive the deployment of Auto-Adjudication methodologies and Robotic Process Automation (RPA/Bots). - Operational Excellence: Oversee workforce planning, process improvement, and staff development for department managers and supervisors. - Compliance & Quality: Ensure regulatory compliance across all areas, specifically driving NM Medicaid compliance for encounter metrics and Turnaround Times (TATs). - Financial Stewardship: Monitor department budgets, manage monthly variance reporting, and maximize Medicaid rate-setting through encounter resolution. - Technical Innovation: Partner with technical SMEs to enhance automation, innovation, and process simplification. Leverage BI tools and data visualization (Tableau) to provide decision support. - Vendor Management: Manage key vendors to validate contract compliance on claims transactions and encounter acceptance measures. - Cross-Functional Collaboration: Support the resolution of complex benefit and provider process issues, collaborating with Configuration, IS, Enrollment, and Member Services. What You Will Bring - Education: Bachelor’s degree in Finance, Business, Healthcare, or a related field (MBA preferred). - Experience: 10+ years of healthcare-specific operational leadership with a focus on Health Plan Claims Operations. - Leadership: 5+ years of experience leading within a complex, highly matrixed function. - Industry Knowledge: Deep understanding of Health Care industry operations, delivery models, and revenue models. - Technical Plus: Experience with Jiva and HRP is highly preferred. You Will Be Successful If: - You have a proven track record of navigating and influencing within highly matrixed environments. - You are an expert at diagnosing and resolving complex problems through a systems-thinking approach. - You can effectively educate employees and transfer knowledge to improve functional effectiveness. - You are skilled at communicating complex ideas and data-driven outcomes to various executive audiences. Important Details - Residency Requirement: Candidates must reside in one of the following states: NM, CA, IL, ND, NY, OH, WA, or WY. - Industry Requirement: Previous experience within a Health Plan or Managed Care Organization is required. - Citizenship: Candidates must be a US Citizen or Green Card holder.

HJ Staffing is seeking a visionary Solutions Architect to bridge the gap between business needs and IT capabilities. In this role, you will design and analyze technology solutions that address complex healthcare business challenges, ensuring they deliver measurable value through robust architecture and modern cloud integrations. What You Will Do - Architectural Design: Analyze and design end-to-end solutions, including data integrations, application components, and detailed technology specifications for network, compute, and storage. - Cloud & Hybrid Infrastructure: Define deployment configurations for on-premises and cloud-based systems (AWS, Azure, or Google Cloud). - Legacy Transformation: Lead strategic migrations from legacy systems to modern, scalable solutions while identifying and eliminating technical debt. - Integrations Mastery: Capture and lead complex data integrations using HL7, FTP, and APIs to ensure seamless interoperability. - Cross-Functional Collaboration: Engage face-to-face with business partners, clients, and IT teams to develop budgets, timelines, and technical blueprints. - Solution Integrity: Work across multiple teams to ensure security, performance, maintainability, scalability, and reliability are embedded in every solution. - Vendor Integration: Partner with external vendors to integrate their products and services into the proposed architectural ecosystem. What You Will Bring - Experience: 10+ years in application support and deployment; 5+ years specifically focused on healthcare data integration is highly preferred. - Education: Bachelor’s degree or 6 years of equivalent professional experience. - Industry Context: Direct experience within a Health Plan or Managed Care Organization is required. - Technical Mastery: Proficiency in system modeling and diagramming tools; experience architecting highly available systems with load balancing and horizontal scalability. - Compliance: Strong understanding of HIPAA, PHI, and PCI compliance standards. - Preferred Tools: Hands-on experience with Jiva and HRP is a significant advantage. You Will Be Successful If: - You are an expert communicator capable of translating business specifications into technical requirements for all levels of management. - You have a deep understanding of healthcare workflows and can align technology with business objectives to maximize ROI. - You are a lifelong learner who quickly adapts to new technologies and emerging cloud frameworks. - You thrive in a collaborative, fast-paced environment where you balance innovation with regulatory constraints. Important Details - Residency Requirement: Candidates must currently reside in one of the following states: NM, CA, IL, ND, NY, OH, WA, or WY. - Remote Status: This position is 100% remote. - Citizenship: Candidates must be a US Citizen or Green Card holder