The EDI Technical Specialist sets up, maintains, and supports Alliance EDI processes to include business analysis, configuration, coding, peer and quality assurance testing, and final documentation. Incumbents apply professional experience, including analysis, process design, modification, configuration, data mapping and maintenance of application programs, integrated systems, and software solutions.

This position is full-time remote. Selected candidate must reside in North Carolina. Some travel for onsite meetings at the home office (Morrisville, NC) may be required.

Responsibilities & Duties

Core Tasks

• Develop a detailed knowledge of the underlying business requirements and available data and support innovative solutions to solve critical business EDI needs
• Assist with the development, testing, implementation, and ongoing maintenance of the HIPAA X12 837 claims, 835 remittance, 834 eligibility, 999 response and other EDI files.
• Provide support to all EDI related production processes and develop and modify all EDI maps for trading partners
• Assist with the design and maintenance of all EDI maps to ensure compliance to all business requirements and analyze all EDI implementations and recommend improvements to processes and coordinate and communicate with all trading partners to resolve all reported issues effectively
• Run and upload HIPAA claims and eligibility files from and to various trading partners based on a corporate schedule
• Process rejection reports associated with daily remittance files, correct rejected transactions, and resubmit the transaction. Work with trading partners to resolve any operational issues
• Support day-to-day operations of multiple HIPAA X12 EDI transactions, including EDI mapping for 834, 837, 270, 277CA, 275, 276, 278, and identifying any technical problems with sending/receiving these transactions.
• Execute SQL (structured query Language) scripting to store, extract and manipulate data from relational database interfaces
• Research and review electronic data received from providers/vendors to ensure presence and accuracy of critical X12 EDI data elements
• Support the configuration and mapping of EDI and other transactional datasets utilizing provided systems and tools
• Review system setup and processes on an on-going basis to ensure accurate and optimum setup for data processing
• Research all EDI questions and investigate errors and problems in timely manner; tracking issues and follow up with the appropriate inner-departmental teams or external providers or vendors as needed
• Provide technical support for healthcare electronic data interchange applications

Collaborate with Internal Staff

• Work collaboratively with internal departments to ensure the HIPAA transactions are provided to the trading partners timely and all reported failed records are corrected and resubmitted by the trading partner
• Collaborate with LME/MCO staff to assist in determining future technology needs as it relates to EDI files
• Provide business systems support in response to user input
• Respond to inquiries regarding EDI issues with enrollment, claims, payments, and/or clearinghouse activities
• Conduct analysis of EDI transactions

Develop and Maintain Documentation and Tracking

• Document, track, monitor and escalate support requests to ensure a timely resolution
• Develop EDI Companion Guides working with Trading Partners to meet these standards
• Monitor and documents all EDI requests and track all applications and participate in necessary IT and claims meetings
• Document all EDI solutions for system development life cycle and maintain all documents specifications and develop various transaction specifications as per requirement

Ensure Continuous Quality Improvement

• Analyze the present business practices and processes and find ways to improve them through a continuous performance improvement plan
• Works with outside agencies to increase knowledge and share information as needed to provide the best possible solutions to end users

Reporting

• Create reports based on Client Services and other department requests

Address Technical Issues

• Respond to email, phone calls and support requests tickets from employees and customers seeking help with software or computer related issues
• Interface with providers, vendors, and internal departments to provide first level support and to address technical and procedural issues related to EDI
• Contact Software providers as needed

Minimum Requirements

Education & Experience

Required:

Graduation from a Community College or Technical School with a two-year degree in an information technology, data science, business administration, healthcare administration or related field and five (5) years of EDI business analyst or related experience that includes managing projects and complex software applications.

Military training and education in the field of work related to the position's role may be substituted on a year-for-year basis.

Preferred:

Bachelor’s degree from accredited university in an information technology or related field and three (3) years of EDI business analyst experience that includes managing projects and complex software applications.

Previous experience with a focus on HIPAA transactions in a healthcare agency

Knowledge, Skills, & Abilities

• Comprehensive knowledge of EDI applications system configuration
• Specialized knowledge EDI Transaction sets
• Thorough knowledge of EDI HIPAA files and experience in developing and maintaining EDI file mappings.
• General EDI healthcare transaction set knowledge
• Excellent knowledge and understanding of databases and database queries using SQL, Crystal Reports or other query tools
• Knowledge of and experience with utilizing desktop business applications, particularly MS Word, MS Excel, MS Project, MS Access
• Organizational and problem-solving skills
• Excellent communication skills and the ability to address diverse groups of internal and external personnel
• Ability to establish and maintain effective working relationships with technical staff and other staff
• Ability to follow oral and written instructions and work without constant supervision
• Ability to interview users and translate needs to application solutions
• Ability to solve problems; ability to manage several projects at the same time
• Ability to prepare technical reports and manuals
• General knowledge of Managed Care operations

Salary Range

$74,520 - $124,200/Annually

Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity.

Education

• Bachelors or better in Information Technology
• Technical/other training or better in Information Technology

Skills

• SQL