Lead EDI Specialist

The NC Dept. of Health and Human Services (DHHS) is seeking a Lead EDI Specialist to perform work related to supporting 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 relationships/standards/envelopes 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 manner
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

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, and Eligibility

Highly desired

Experience setting up users/new trading partner relationships/standards/envelopes 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 to 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