HYBRID Senior EDI Developer 795706

Must be a resident in Indianapolis, IN.

Short Description

We are seeking an EDI expert in order to maintain and advance our client's health insurance claims processing system.

Complete Description

The EDI Expert is responsible for maintaining the life cycle of claims as they arrive from health providers, 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 client’s health insurance claims 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 client’s CSHCS system
• Assist in onboarding new providers
• Assist in onboarding new clearinghouses
• Ability to work independently with little guidance and work with externals partners as needed.

Requirements

• Bachelor's Degree in Computer Science or related fields with IT experience
• 5 years' experience with database knowledge
• 5 years' experience understanding EDI file formats (835, 837, 210)
• Knowledge of HIPAA regulations
• Ability to solve complex troubleshooting issues
• Excellent verbal and written communication skills

Preferred skills

• Health industry experience
• Knowledge of IBM Websphere (WTX)
• Database/SQL experience