Lead EDI Specialist
*Local to Raleigh NC, only please
*This is a hybrid position
Description:
- The client is seeking a Lead EDI Specialist to perform work related to support the Medicaid Reform Project.
Responsibilities:
- 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
Required Skills/Knowledge/Experience:
- Expert in developing and executing test scripts related to X12 EDI Transmission, Required 7 Years
- Demonstrated proficiency in conducting QA and testing on EDI applications, Required 5 Years
- Expert in EDI mapping for 837, 277CA, 834, 835, TA1, 999, 820, NCPDP D.0, Required 5 Years
- High degree of business and technical knowledge with significant practical experience in HIPAA X12 EDI Transactions., Required 5 Years
- Strong understanding of healthcare claims processing – Claims, Provider, Eligibility, Highly desired
- Experience setting up users/new Trading Partner relationship/Standards/Envelope and full cycle testing, Required 2 Years
- Experience in creating and managing catalog of EDI document types such as 837, 277CA, 834, 835, TA1, 999, 820, NCPDP D.0, Required 3 Years
- Working knowledge of Medicaid and/or MMIS, Highly desired
- Excellent verbal and written communication skills with the ability present to both technical and business audiences., Desired
- Proven experience in processing and monitoring all inbound and outbound X12 transactions, Required 3 Years
- Knowledge of Agile Methodology, Required 2 Years
- Experience in collaborating with EDI partners to resolve transmission problems., Required 2 Years
- LOCAL candidates only, Required
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