Senior EDI Developer

Position Overview


The client is seeking an EDI expert in order to maintain and advance its health insurance claims processing system, ACAPS.

The EDI Expert is responsible for maintaining the life cycle of claims as they arrive from health providers at client, 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 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, client standards, and 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 less guidance and work with client externals partners as needed.

Skill - Required / Desired - Amount of Experience
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

Notes:
Required to work onsite 3 days per week and 2 days remote.

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.