Lead EDI Specialist

3 weeks ago

Raleigh, United States Crescens Full time
Job Title: Lead EDI Specialist
Location: Raleigh, NC (Onsite)
Duration: 11+months
Type: Contract

Once COVID-19 restrictions are lifted, all work must be completed on site.

Job Description:
  • 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:
  • Expert in developing and executing test scripts related to X12 EDI Transmission
  • Demonstrated proficiency in conducting QA and testing on EDI applications
  • Expert 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.
  • 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
  • Working knowledge of Medicaid and/or MMIS
  • 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
  • Knowledge of Agile Methodology
  • Experience in collaborating with EDI partners to resolve transmission problems.
  • LOCAL candidates only

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