Electronic Data Interchange Specialist

Title: Lead EDI Specialist/Tester

Location: Raleigh, NC (Hybrid)

Duration: 6 Months

Type: Contract

Note: Once COVID-19 restrictions are lifted, all work must be completed on site. Do you accept this requirement?

Description:

The client is seeking a Lead EDI Specialist / Tester to perform work related to support the Managed Care Transition 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 application
• 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 Skills:

• Expert in developing and executing test scripts related to X12 EDI transmissions
• Demonstrated proficiency in QA and testing of EDI applications
• Expert-level experience in EDI mapping for transactions including 837, 277CA, 834, 835, TA1, 999, 820, and NCPDP D.0
• Strong business and technical knowledge with hands-on experience in HIPAA X12 EDI transactions
• Solid understanding of healthcare claims processing, including Claims, Provider, and Eligibility workflows
• Experience setting up users and new trading partner relationships, including standards, envelopes, and full-cycle testing
• Experience creating and managing a catalog of EDI document types (837, 277CA, 834, 835, TA1, 999, 820, NCPDP D.0)
• Working knowledge of Medicaid and/or MMIS systems
• Proven experience processing and monitoring inbound and outbound X12 transactions
• Experience collaborating with EDI trading partners to identify and resolve transmission issues
• Knowledge of Agile methodology
• Excellent verbal and written communication skills, with the ability to present to both technical and business audiences
• Local candidate availability