EDI Developer

JOB SUMMARY


The EDI Expert is responsible for maintaining the life cycle of claims as they arrive from health providers at IDOH, 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.

Key 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 IDOH's ACAPS 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.

o Provide support to healthcare providers who interact with IDOH's CSHCS system


o Assist in onboarding new providers


o Assist in onboarding new clearinghouses

• Ability to work independently with less guidance and work with ISDH externals partners as needed.

Required Qualifications

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

Preferred Qualifications

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

Education/Experience

• Bachelor's Degree in Computer Science or related fields with IT experience

Skill Matrix


Skill


Required / Desired


Years of Experience


Response


Bachelor's Degree in Computer Science or related fields with IT experience


Required


Database knowledge


Required


5 Years


Understanding EDI file formats (835, 837, 210)


Required


5 Years


Knowledge of HIPAA regulations


Required


Ability to solve complex troubleshooting issues


Required


Excellent verbal and written communication skills


Required


Health Industry experience


Highly desired


Knowledge of IBM Websphere (WTX)


Highly desired


Database/SQL experience


Highly desired

Compliance Requirements / Client Questions


Question


Description


Response


Question 1


Absences greater than two weeks MUST be approved by CAI management in advance, and contact information must be provided to CAI so that the resource can be reached during his or her absence. The Client has the right to dismiss the resource if he or she does not return to work by the agreed upon date. Do you agree to this requirement?


Question 2


Please provide candidate's email address.


Question 3


Candidate must be local to Indianapolis. Please provide current home address.


Question 4


The candidate pay rate for this position is $59.06. The Provider Markup for this position is 35%. Do you agree to these requirements?


Question 5


Selected resource will be required to work onsite 3 days per week and 2 days remote. Please confirm the resource understands this requirement.


Question 6


Initial technical interview will be via Teams. Final interview will be via Teams or in person, per the request of the manager. Please confirm the resource understands the interview process.


Question 7


Position is expected to extend past 8/15/2026. Please confirm the resource understands this requirement.