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

Skill Matrix

• Expert in developing and executing test scripts related to X12 EDI Transmission Required 7 Years
• Demonstrated proficiency in conducting QA and testing on EDI applications Required 5 Years
• Expert in EDI mapping for 837, 277CA, 834, 835, TA1, 999, 820, NCPDP D.0 Required 5 Years
• High degree of business and technical knowledge with significant practical experience in HIPAA X12 EDI Transactions. Required 5 Years
• Strong understanding of healthcare claims processing - Claims, Provider, Eligibility Highly desired
• Experience setting up users/new Trading Partner relationship/Standards/Envelope and full cycle testing Required 2 Years
• Experience in creating and managing catalog of EDI document types such as 837, 277CA, 834, 835, TA1, 999, 820, NCPDP D.0 Required 3 Years
• Working knowledge of Medicaid and/or MMIS Highly desired
• Excellent verbal and written communication skills with the ability present to both technical and business audiences. Desired
• Proven experience in processing and monitoring all inbound and outbound X12 transactions Required 3 Years
• Knowledge of Agile Methodology Required 2 Years
• Experience in collaborating with EDI partners to resolve transmission problems. Required 2 Years
• LOCAL candidates only Required