Lead EDI Specialist

Company:  Crescens Inc.
Location: Raleigh
Closing Date: 29/11/2024
Hours: Full Time
Type: Permanent
Job Requirements / Description
Job Title: Lead EDI Specialist

Location: Raleigh, NC (Onsite)

Duration: 11+months

Type: Contract

Once COVID-19 restrictions are lifted, all work must be completed on site.

Job Description:

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 department

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

Required:

Expert in developing and executing test scripts related to X12 EDI Transmission

Demonstrated proficiency in conducting QA and testing on EDI applications

Expert in EDI mapping for 837, 277CA, 834, 835, TA1, 999, 820, NCPDP D.0

High degree of business and technical knowledge with significant practical experience in HIPAA X12 EDI Transactions.

Strong understanding of healthcare claims processing - Claims, Provider, Eligibility

Experience setting up users/new Trading Partner relationship/Standards/Envelope and full cycle testing

Experience in creating and managing catalog of EDI document types such as 837, 277CA, 834, 835, TA1, 999, 820, NCPDP D.0

Working knowledge of Medicaid and/or MMIS

Excellent verbal and written communication skills with the ability present to both technical and business audiences.

Proven experience in processing and monitoring all inbound and outbound X12 transactions

Knowledge of Agile Methodology

Experience in collaborating with EDI partners to resolve transmission problems.

LOCAL candidates only

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