What are the responsibilities and job description for the Senior EDI Developer position at OP Consulting Group LLC?
Complete Description:
The EDI Expert is responsible for maintaining the life cycle of claims as they arrive from health providers at Client, 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 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 SME as Client’s ACAPS system is rewritten in .Net.
- Act as liaison between 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 the 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 Client’s CSHCS system.
- Assist in onboarding new providers.
- Assist in onboarding new clearinghouses.
- Ability to work independently with less guidance and work with Client externals partners as needed.
Agency Interview Type:
Phone and in-person
Work Arrangement:
Hybrid
Salary : $59