Lead EDI Specialist

Lead EDI Specialist

Job Description

The client 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 client:
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
Conducts QA and Testing on EDI applications
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 client
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

Skill - Required / Desired - Amount of Experience
Expert in developing and executing test scripts related to X12 EDI Transmission - Required - 7 Years
Demonstrated proficiency in conducting QA and testing on EDI applications - Required - 5 Years
Expert in EDI mapping for 837, 277CA, 834, 835, TA1, 999, 820, NCPDP D.0 - Required - 5 Years
High degree of business and technical knowledge with significant practical experience in HIPAA X12 EDI Transactions. - Required - 5 Years
Strong understanding of healthcare claims processing - Claims, Provider, Eligibility - Highly desired
Experience setting up users/new Trading Partner relationship/Standards/Envelope and full cycle testing - Required - 2 Years
Experience in creating and managing catalog of EDI document types such as 837, 277CA, 834, 835, TA1, 999, 820, NCPDP D.0 - Required - 3 Years
Working knowledge of Medicaid and/or MMIS - Highly desired
Excellent verbal and written communication skills with the ability present to both technical and business audiences. - Desired
Proven experience in processing and monitoring all inbound and outbound X12 transactions - Required - 3 Years
Knowledge of Agile Methodology - Required - 2 Years
Experience in collaborating with EDI partners to resolve transmission problems. - Required - 2 Years

Notes:
Hybrid

VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.