IT Lead EDI Specialist

Job Title: IT Lead EDI Specialist (HYBRID)

Location: Raleigh, NC

Duration: 12+ Months

Job Description:

The client is seeking a Lead EDI Specialist to perform work related to to support the Medicaid Reform Project.

This position is responsible for the following activities related to a critical system being developed in-house at the State:

• High degree of business and technical knowledge with significant practical experience in HIPAA X12 EDI Transactions
• Expert in EDI mapping for 837, 277CA, 834, 835, TA1, 999, 820, NCPDP D.0
• Develop and execute test scripts related to X12 Transmission
• Conducts QA and Testing on EDI applications
• Develop and execute Test scripts related to X12 Transmission
• Experience setting up users/new Trading Partner relationship/Standards/Envelope and full cycle testing
• Provides technical support during and after implementation for healthcare electronic data interchange applications
• Responds to inquiries regarding EDI issues with encounter claims and trading partner activities
• Management of catalog of EDI document types such as 837, 277CA, 834, 835, TA1, 999, 820, NCPDP D.0
• Communication between Trading Partners and department
• Maintain detailed documentation and process flow of all EDI processes
• Identify and facilitate issues with partner data mapping from onset through completion
• Process and monitor all inbound and outbound X12 transactions
• Support Customer Service group with EDI related issues
• Identifies, recommends and implements process improvements in support of the EDI system
• Troubleshoot EDI document processing errors and work with trading partners directly to resolve in a timely matter
• Conducts analysis of EDI transactions and is responsible for documentation and reports
• Collaborate with EDI partners to resolve transmission problems
• Track day-to-day EDI & batch processes to identify and address problems as they arise reporting levels of activity using key established metrics for senior management
• Effectively communicate issues and needs with internal business partners, external vendors, and healthcare providers
• Develops and maintains cross walking and validation rules for file exchanges
• Triages incoming EDI issues thru monitoring
• Ability to communicate effectively with technical and business staff
• Support internal resources to resolve issues, answer questions, and retransmit EDI documents when necessary
• Work with end users to ensure user acceptance testing is thorough and complete
• Employees should be able to work independently with minimal supervision
• Knowledge of Agile Methodology
  
  

Skills:

SkillRequired / DesiredAmountof ExperienceExpert in developing and executing test scripts related to X12 EDI TransmissionRequired7YearsDemonstrated proficiency in conducting QA and testing on EDI applicationsRequired5YearsExpert in EDI mapping for 837, 277CA, 834, 835, TA1, 999, 820, NCPDP D.0Required5YearsHigh degree of business and technical knowledge with significant practical experience in HIPAA X12 EDI Transactions.Required5YearsStrong understanding of healthcare claims processing - Claims, Provider, EligibilityHighly desiredExperience setting up users/new Trading Partner relationship/Standards/Envelope and full cycle testingRequired2YearsExperience in creating and managing catalog of EDI document types such as 837, 277CA, 834, 835, TA1, 999, 820, NCPDP D.0Required3YearsWorking knowledge of Medicaid and/or MMISHighly desiredExcellent verbal and written communication skills with the ability present to both technical and business audiences.DesiredProven experience in processing and monitoring all inbound and outbound X12 transactionsRequired3YearsKnowledge of Agile MethodologyRequired2YearsExperience in collaborating with EDI partners to resolve transmission problems.Required2YearsLOCAL candidates onlyRequired

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