IT Systems & API Integration Manager
The purpose of the
IT Systems & API Integration Specialist is to support and optimize the organization's healthcare technology infrastructure, system integrations, and data exchange processes to ensure efficient operations across the IPA/MSO environment. This position is responsible for maintaining and enhancing QuickCap and related healthcare systems, developing API integrations, improving data accuracy and automation, and supporting operational departments including claims, eligibility, contracting, credentialing, quality, and population health. The role helps ensure timely and secure exchange of healthcare data while supporting organizational growth, compliance, and operational efficiency within managed care and value-based healthcare programs.
JOB TYPE & WORK LOCATION- On-site - Alhambra, California
- Full-time
ESSENTIAL DUTIES & RESPONSIBILITIES- Manage and support QuickCap system operations, maintenance, and troubleshooting
- Develop, maintain, and monitor API integrations between internal systems, health plans, clearinghouses, and vendors
- Support healthcare EDI transactions including:
- 837 Claims
- 835 Remittance
- 270/271 Eligibility
- 278 Authorization
- 834 Enrollment files
- Assist with provider roster management, membership files, capitation reports, and claims data imports/exports
- Coordinate system integrations with health plans, MSOs, EMRs/EHRs, laboratories, and third-party vendors
- Work with operations, claims, contracting, credentialing, and quality departments to improve workflows and automation
- Troubleshoot system issues related to eligibility, authorizations, claims, encounters, and provider data
- Create reports, dashboards, and automated data processes using SQL, Excel, or reporting tools
- Monitor data integrity and ensure HIPAA compliance and data security standards are maintained
- Support system upgrades, testing, implementation, and user training
- Document technical processes, workflows, APIs, and integration specifications
- Collaborate with vendors and internal leadership on IT initiatives and operational improvements
- Assist with population health, RAF/HCC, quality measure, and care gap data integrations when needed
REQUIRED QUALIFICATIONS- Minimum 3-4 years of IT experience within:
- IPA
- MSO
- Managed Care
- Health Plan
- Medical Group environment
- Hands-on experience with QuickCap strongly preferred
- Experience working with APIs, system integrations, and healthcare data exchange
- Understanding of healthcare EDI formats and managed care operations
- Knowledge of claims processing, eligibility, provider data, and capitation workflows
- Experience with SQL queries, database management, and reporting tools
- Familiarity with HIPAA compliance and healthcare data security standards
- Strong analytical, troubleshooting, and problem-solving skills
- Excellent communication and project coordination abilities
- Ability to manage multiple projects and deadlines in a fast-paced healthcare environment
PREFERRED SKILLS/EXPERIENCE- Experience with:
- HL7/FHIR integrations
- API platforms
- Clearinghouse integrations
- Population health systems
- Cozeva or healthcare analytics platforms
- Microsoft SQL Server
- Power BI or Tableau
- Understanding of Medicare Advantage and Medi-Cal managed care operations
- Experience supporting delegated healthcare environments
EDUCATION- Bachelor's degree in Information Technology, Computer Science, Healthcare Informatics, or related field preferred
PREFERRED CERTIFICATIONS- CompTIA A+, Network+, or Security+ certification preferred.
- Microsoft SQL, Azure, or related database certification preferred.
- Healthcare Information and Management Systems Society (HIMSS) preferred certification.
- Relevant API, interoperability, or healthcare IT certifications preferred.
