What are the responsibilities and job description for the Senior EDI Developer position at OP Consulting Group LLC?
The EDI Expert is responsible for maintaining the life cycle of claims as they arrive from health providers and are loaded into our database, 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 project activities.
Essential Duties / Responsibilities
- Review and update all documentation related to claims processing and EDI transactions.
- Identify incompletely documented claims processing and EDI processes, and document them.
- Work with the development team as a Subject Matter Expert as IDOH’s ACAPS system is rewritten in .Net.
- Act as a liaison between the OTC team and the Children’s program area on claims processing issues.
- Work with technical and functional staff on detailed business requirements, understanding business processes and technology, agency standards, federal and state policies to align with project 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, including support to healthcare providers who interact with IDOH’s CSHCS system and assist in onboarding new providers and clearinghouses.
- Ability to work independently with minimal guidance and work with ISDH external partners as needed.
Skills
- Bachelor''s Degree in Computer Science or related fields with IT experience - Required
- Database knowledge - Required, 5 Years
- Understanding EDI file formats (835, 837, 210) - Required, 5 Years
- Knowledge of HIPAA regulations - Required
- Ability to solve complex troubleshooting issues - Required
- Excellent verbal and written communication skills - Required
- Health Industry experience - Highly desired
- Knowledge of IBM Websphere (WTX) - Highly desired
- Database/SQL experience - Highly desired
Salary : $59