Edifecs Technical Lead

As an Edifecs Developer you will design, build, and support EDI solutions for US healthcare claims processing. You will work mainly with HIPAA X12 837 (Professional, Institutional, and Dental) transactions, using the Edifecs platform to implement validation, transformation, and routing between clearinghouses, web applications and internal claims systems.

Mandatory skills: -

• Hands-on experience with Edifecs Smart Trading Platform (XEngine, Specbuilder, Transaction Management)
• Strong understanding of US healthcare claims workflows (submission, adjudication, rejections/denials, remittance) and terminology such as payer, provider, clearinghouse, ICD-10, CPT/HCPCS, and NPI.
• Proficiency in SQL (Oracle, SQL Server, or PostgreSQL) for data analysis and troubleshooting.
• Experience with XML/XSD, XSLT, and flat-file and delimited-file formats.
• Strong analytical, debugging, and problem-solving skills.

Good to have:

• Edifecs certification, HIPAA/EDI certification (e.g., X12 or AHIMA/HIMSS-related), or relevant healthcare IT training.

Responsibilities: -

• Design, develop, and maintain EDI solutions using Edifecs (XEngine, Specbuilder, Transaction Management, or equivalent) for inbound and outbound 837P, 837I, and 837D transactions.
• Build and configure HIPAA X12 validation rules, including SNIP levels 1-7, and implement custom payer-specific business rules.
• Develop maps and transformations between X12 and internal formats (XML, JSON, flat files, database structures).
• Create and maintain trading partner profiles, companion guides, and partner-specific configurations.
• Analyze 837 implementation guides (5010) and translate requirements into technical designs.
• Process and reconcile related transactions such as 999/TA1 acknowledgments, 277CA claim acknowledgments, 835 remittances, and 276/277 claim status.