EDI Specialist at The Evolvers Group
Raleigh, NC
About the Job
We are seeking a Lead EDI Specialist to perform work related to support the Medicaid Reform Project.
Required Experience:
- Expert experience in developing and executing test scripts related to X12 EDI Transmission.
- Experience and demonstrated proficiency in conducting QA and testing EDI applications.
- Expert experience in EDI mapping for 837, 277CA, 834, 835, TA1, 999, 820, NCPDP D.0
- High degree of business and technical knowledge with significant practical experience in HIPAA X12 EDI Transactions.
- Experience and strong understanding of healthcare claims processing - Claims, Provider, Eligibility.
- Experience setting up users/new Trading Partner relationship/Standards/Envelope and full cycle testing.
- Experience in creating and managing catalog of EDI document types such as 837, 277CA, 834, 835, TA1, 999, 820, NCPDP D.0.
- experience and working knowledge of Medicaid and/or MMIS.
- Experience demonstrating excellent verbal and written communication skills with the ability present to both technical and business audiences.
- Proven experience in processing and monitoring all inbound and outbound X12 transactions.
- Experience and knowledge of Agile Methodology.
- Experience in collaborating with EDI partners to resolve transmission problems.
Responsibilities:
- Develop and execute test scripts related to X12 Transmission.
- Conducts QA and Testing on EDI applications.
- 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.
- Respond to inquiries regarding EDI issues with encounter claims and trading partner activities.
- Manage catalog of EDI document types such as 837, 277CA, 834, 835, TA1, 999, 820, NCPDP D.0.
- Communicate with 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.
- Identify, recommend and implement 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.
- Conduct 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.
- Develop and maintain cross walking and validation rules for file exchanges.
- Triage incoming EDI issues through monitoring.