What are the responsibilities and job description for the Lead EDI Specialist position at O2 Technologies,Inc?
About The Role
DHHS- IT Lead EDI Specialist
North Carolina
NC Dept of Health and Human Services (DHHS) is seeking a Lead EDI Specialist / Tester to perform work related to support the Managed Care Transition Project.
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:
Develop and execute Test scripts related to X12 Transmission
Experience setting up users/new Trading Partner relationship/Standards/Envelope and full cycle testing
Expert in developing and executing test scripts related to X12 EDI Transmission
Demonstrated proficiency in conducting QA and testing on EDI applications
Expert in EDI mapping for 837, 277CA, 834, 835, TA1, 999, 820, NCPDP D.0
High degree of business and technical knowledge with significant practical experience in HIPAA X12 EDI Transactions.
Strong understanding of healthcare claims processing - Claims, Provider, Eligibility
Experience setting up users/new Trading Partner relationship/Standards/Envelope and full cycle testing
Experience in creating and managing catalog of EDI document types such as 837, 277CA, 834, 835, TA1, 999, 820, NCPDP D.0
Working knowledge of Medicaid and/or MMIS
Excellent verbal and written communication skills with the ability present to both technical and business audiences.
Proven experience in processing and monitoring all inbound and outbound X12 transactions
Knowledge of Agile Methodology
Experience in collaborating with EDI partners to resolve transmission problems.
LOCAL candidates only
Key Responsibilities & Skills
Bachelor's Degree in Health Information Management, Healthcare Informatics, Computer Science, Information Systems, Public Health, Business Administration. Preferred: Master's in Health Informatics, Master's in Healthcare Administration, Master's in Business Administration (MBA), Master's in Information Systems.
Industry Experience
DHHS- IT Lead EDI Specialist
North Carolina
NC Dept of Health and Human Services (DHHS) is seeking a Lead EDI Specialist / Tester to perform work related to support the Managed Care Transition Project.
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
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
Expert in developing and executing test scripts related to X12 EDI Transmission
Demonstrated proficiency in conducting QA and testing on EDI applications
Expert in EDI mapping for 837, 277CA, 834, 835, TA1, 999, 820, NCPDP D.0
High degree of business and technical knowledge with significant practical experience in HIPAA X12 EDI Transactions.
Strong understanding of healthcare claims processing - Claims, Provider, Eligibility
Experience setting up users/new Trading Partner relationship/Standards/Envelope and full cycle testing
Experience in creating and managing catalog of EDI document types such as 837, 277CA, 834, 835, TA1, 999, 820, NCPDP D.0
Working knowledge of Medicaid and/or MMIS
Excellent verbal and written communication skills with the ability present to both technical and business audiences.
Proven experience in processing and monitoring all inbound and outbound X12 transactions
Knowledge of Agile Methodology
Experience in collaborating with EDI partners to resolve transmission problems.
LOCAL candidates only
Key Responsibilities & Skills
- HIPAA X12 EDI Transactions
- EDI Mapping (837, 277CA, 834, 835, TA1, 999, 820, NCPDP D.0)
- Test Script Development & Execution
- QA & Testing of EDI Applications
- Trading Partner Management & Setup
- Medicaid / MMIS Knowledge
- Healthcare Claims Processing
- Process Improvement & Optimization
- Documentation & Process Flow Management
- Stakeholder Communication & Issue Resolution
- Agile Methodology Experience
- Cross-walk & Validation Rule Development
- Issue Triage & Monitoring
- Batch Processing & Transaction Monitoring
- EDI X12 / NCPDP D.0 Standards
- EDI Mapping Software (Liaison / Mirth Connect)
- Testing & QA Tools (Test Scripts / Automated Validators)
- Trading Partner Management Platforms
- Agile Project Management Tools (JIRA / Azure Boards)
- Healthcare Integration Engine (Rhapsody / Cloverleaf)
Bachelor's Degree in Health Information Management, Healthcare Informatics, Computer Science, Information Systems, Public Health, Business Administration. Preferred: Master's in Health Informatics, Master's in Healthcare Administration, Master's in Business Administration (MBA), Master's in Information Systems.
Industry Experience
- State Government Health Services
- Medicaid & MMIS Programs
- Healthcare Insurance & Managed Care
- Health IT & Integration
- Public Health Administration