DHHS- IT Lead EDI Specialist

3 weeks ago


Wilmington, United States NR Consulting Full time

Short Description: NC Dept of Health and Human Services (DHHS) is seeking a Lead EDI Specialist / Tester to perform work related to support the Managed Care Transition Project.

Complete Description: NC Dept of Health and Human Services (DHHS) 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

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