What are the responsibilities and job description for the Senior EDI Developer position at Real Soft, Inc / Diversity Direct?
Position Overview
Seeking an EDI Expert to support and enhance its health insurance claims processing system, ACAPS. The selected candidate will be responsible for maintaining the complete lifecycle of healthcare claims processing, including EDI transaction management, claims adjudication, provider communications, troubleshooting, and support for healthcare providers and trading partners.
This role will collaborate closely with project managers, software developers, business analysts, and functional teams while serving as a Subject Matter Expert (SME) during the modernization of the ACAPS system to .NET.
Key Responsibilities
- Review, update, and maintain documentation related to claims processing and EDI transactions.
- Identify undocumented claims processing workflows and create detailed documentation.
- Serve as the EDI and claims processing SME during the ACAPS system migration to .NET.
- Act as a liaison between technical teams and business stakeholders regarding claims processing issues.
- Analyze business requirements and translate them into technical specifications.
- Support system testing, validation, and implementation activities.
- Ensure accurate EDI file exchanges with external trading partners.
- Troubleshoot and resolve EDI transmission and claims processing issues.
- Provide support for healthcare providers interacting with the CSHCS system.
- Assist with onboarding new healthcare providers and clearinghouses.
- Work independently while collaborating with internal and external stakeholders.
Required Qualifications
- Bachelor’s Degree in Computer Science, Information Technology, or a related field.
- 5 years of experience with EDI transactions and healthcare claims processing.
- Strong understanding of EDI file formats including:
- 835
- 837
- 210
- Knowledge of HIPAA regulations and compliance requirements.
- Experience working with databases and data management.
- Strong troubleshooting and problem-solving skills.
- Excellent verbal and written communication abilities.
Preferred Qualifications
- Healthcare industry experience.
- Experience with healthcare claims adjudication systems.
- IBM WebSphere Transformation Extender (WTX) experience.
- Strong SQL and database experience.
- Experience supporting healthcare providers and clearinghouses.
Work Requirements
- Hybrid schedule: 3 days onsite and 2 days remote in Indianapolis, IN.
- Initial interview will be conducted via Microsoft Teams.
- Final interview may be conducted via Teams or in person.
- This is a contract-to-hire opportunity; candidates must be eligible for full-time employment without sponsorship.
Salary : $59