EDI Integration Specialist

Overview
External facing experience is MUST. We are seeking a skilled

Integration Specialist

with strong

Electronic Data Interchange

(EDI)

expertise and a solid understanding of

healthcare domain standards

to design, develop, and maintain integration solutions. This role will focus on implementing, testing, and supporting EDI transactions, ensuring compliance with HIPAA and healthcare industry standards.

Key Responsibilities

Design, develop, and maintain integration solutions for healthcare data exchange using EDI standards (e.g., X12, HL7).

Implement, configure, and support EDI transactions such as

837 (claims), 835

(remittance) ,

270/271 (eligibility) ,

276/277 (claim status) .

Work with healthcare partners, payers, and providers to troubleshoot and resolve integration issues.

Develop mapping, translation, and transformation processes between internal systems and external partners.

Ensure compliance with

HIPAA , security protocols, and industry data exchange requirements.

Collaborate with business analysts, QA teams, and project managers to gather requirements and deliver high-quality integration solutions.

Monitor integration processes and proactively identify performance or data issues.

Maintain detailed technical documentation and provide training or knowledge transfer to internal teams.

Required Skills & Qualifications

Bachelors degree in Computer Science, Information Technology, or related field (or equivalent experience).

5+ years

of experience in integration development, with a strong focus on

EDI

in the healthcare industry.

Proficiency in healthcare EDI standards ( HIPAA X12 ,

HL7 ).

Hands-on experience with integration tools (e.g., MuleSoft, Dell Boomi, Cloverleaf, IBM Sterling Integrator, BizTalk, or similar).

Strong knowledge of healthcare processes including claims, eligibility, payments, and prior authorizations.

Solid understanding of XML, JSON, SQL, REST, and SOAP-based web services.

Strong troubleshooting and problem-solving skills.

Excellent communication and collaboration abilities.

Preferred Qualifications

Experience with cloud-based integration platforms (e.g., Azure Logic Apps, AWS Step Functions, or GCP integrations).

Knowledge of FHIR (Fast Healthcare Interoperability Resources) standards.

Previous work with payer or provider systems.

Familiarity with agile development methodologies.

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