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The IndianaDepartment of Health (IDOH) is seeking an EDI expert in order to maintain and advance its health insurance claims processing system, ACAPS.
The EDI Expert is responsible for maintaining the life cycle of claims as they arrive from health providers at IDOH, are loaded into our database, are adjudicated based on state and national pricing standards, and as adjudication messages are generated and sent back to the originating provider. This position will work with the project manager, software developers, business analysts, and functional team members on the project activities.
Essential Duties / Responsibilities:
Review update all documentation related to claims processing and EDI transactions
Identify incompletely documented claims processing and EDI processes, and document them
Work with development team as a SME as IDOH's ACAPS system is rewritten in .Net
Act as liaison between OTC team and the Children's program area on claims processing issues
Working with technical and functional staff on detailed business requirements, understanding business processes and technology, agency standards, federal and state policies to align with project's goals.
Write technical specifications based on conceptual design and stated business requirements.
Test new and existing systems
Ensure accurate and appropriate file exchanges with external trading partners and resolve EDI data transmission conflicts.
Provide helpdesk level support for EDI claim transactions.
Required/Desired Skills Skill Required /Desired Amount Candidate Experience Bachelor's Degree in Computer Science or related fields with IT experience Required 0 Database knowledge Required 5 Understanding EDI file formats (835, 837, 210) Required 5 Knowledge of HIPAA regulations Required 0 Ability to solve complex troubleshooting issues Required 0 Excellent verbal and written communication skills Required 0 Health Industry experience Highly desired 0 Knowledge of IBM Websphere (WTX) Highly desired 0 Database/SQL experience Highly desired 0 Questions No. Question Answer Question1 Absences greater than two weeks MUST be approved by CAI management in advance, and contact information must be provided to CAI so that the resource can be reached during his or her absence. The Client has the right to dismiss the resource if he or she does not return to work by the agreed upon date. Do you agree to this requirement? Question2 Please provide candidate&# ;s email address. Question3 Candidate must be local to Indianapolis. Please provide City and State the resource resides. Question5 Selected resource will be required to work onsite 3 days per week and 2 days remote. Please confirm the resource understands this requirement. Question6 Initial technical interview will be via Teams. Final interview will be via Teams or in person, per the request of the manager. Please confirm the resource understands the interview process. Question7 The manager has indicated the position is a possible contract to hire opportunity. Candidates presented must be eligible for full time hire, without requiring sponsorship. Please confirm the resource is understanding of this requirement.
The IndianaDepartment of Health (IDOH) is seeking an EDI expert in order to maintain and advance its health insurance claims processing system, ACAPS.
The EDI Expert is responsible for maintaining the life cycle of claims as they arrive from health providers at IDOH, are loaded into our database, are adjudicated based on state and national pricing standards, and as adjudication messages are generated and sent back to the originating provider. This position will work with the project manager, software developers, business analysts, and functional team members on the project activities.
Essential Duties / Responsibilities:
Review update all documentation related to claims processing and EDI transactions
Identify incompletely documented claims processing and EDI processes, and document them
Work with development team as a SME as IDOH's ACAPS system is rewritten in .Net
Act as liaison between OTC team and the Children's program area on claims processing issues
Working with technical and functional staff on detailed business requirements, understanding business processes and technology, agency standards, federal and state policies to align with project's goals.
Write technical specifications based on conceptual design and stated business requirements.
Test new and existing systems
Ensure accurate and appropriate file exchanges with external trading partners and resolve EDI data transmission conflicts.
Provide helpdesk level support for EDI claim transactions.
- Provide support to healthcare providers who interact with IDOH's CSHCS system
- Assist in onboarding new providers
- Assist in onboarding new clearinghouses
Required/Desired Skills Skill Required /Desired Amount Candidate Experience Bachelor's Degree in Computer Science or related fields with IT experience Required 0 Database knowledge Required 5 Understanding EDI file formats (835, 837, 210) Required 5 Knowledge of HIPAA regulations Required 0 Ability to solve complex troubleshooting issues Required 0 Excellent verbal and written communication skills Required 0 Health Industry experience Highly desired 0 Knowledge of IBM Websphere (WTX) Highly desired 0 Database/SQL experience Highly desired 0 Questions No. Question Answer Question1 Absences greater than two weeks MUST be approved by CAI management in advance, and contact information must be provided to CAI so that the resource can be reached during his or her absence. The Client has the right to dismiss the resource if he or she does not return to work by the agreed upon date. Do you agree to this requirement? Question2 Please provide candidate&# ;s email address. Question3 Candidate must be local to Indianapolis. Please provide City and State the resource resides. Question5 Selected resource will be required to work onsite 3 days per week and 2 days remote. Please confirm the resource understands this requirement. Question6 Initial technical interview will be via Teams. Final interview will be via Teams or in person, per the request of the manager. Please confirm the resource understands the interview process. Question7 The manager has indicated the position is a possible contract to hire opportunity. Candidates presented must be eligible for full time hire, without requiring sponsorship. Please confirm the resource is understanding of this requirement.