EDI Specialist

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.