Remote Healthcare EDI Specialist
- Location: New York City, NY
- Start Date: 5/2/2025
- Job ID: 25-00872
- Posting Date: 5/2/2025
- Job Type: Direct Placement
*Candidates must reside in: AZ, CT, FL, GA, IL, IN, KS, KY, MI, NJ, NY, OH, OK, SC, TN, or TX*
The EDI Specialist works with the company's Electronic Data Interchange program, facilitating the establishment of new customer/partner relationships within our EDI environment, including documenting requirements, testing solutions, and ensuring successful implementations.
Responsibilities:
The EDI Specialist works with the company's Electronic Data Interchange program, facilitating the establishment of new customer/partner relationships within our EDI environment, including documenting requirements, testing solutions, and ensuring successful implementations.
Responsibilities:
- Monitor generation and transmission of both inbound and outbound EDI data; perform initial troubleshooting on all processes to resolve content issues and map problems.
- Review/log failures, resolve data issues, and reload data. Collaborate with other departments as needed.
- Pull and load files for non-automated processes.
- Maintain EDI status tracking; prepare reports of results.
- Maintain active relationships with internal and/or external stakeholders to develop business requirements.
- Participate in meetings with stakeholders to gather and document requirements and explore potential solutions.
- Work with development team to develop, define application scope and objectives, and prepare functional and/or technical specifications to accommodate business processes related to EDI.
- Analyzes and classifies complex change request and identifies and documents possible system code enhancements.
- Conduct and lead on all end-to-end testing phases with EDI Trading Partners and Business Users.
- Assist in creating basic test scenarios to be used in testing the business applications to verify that client requirements are incorporated into the system design.
- Identify, recommend, and implement process improvements in support of the EDI system.
- Perform root cause analysis of any production issue and generate solutions to prevent recurrence.
- 3+ years of EDI healthcare transaction processing for eligibility, clinical, claims, accumulator, and provider X12 data.
- Knowledge of healthcare insurance industry claims and eligibility administration experience preferred.
- Hands-on experience with EDI Healthcare X12 Transactions such as 837, 834, 835, 270/271, 278, 276/277, 999.
- Knowledge of industry standard health data code sets such as ICD-10, CPT/HCPCS, revenue codes.
- Knowledgeable with regulatory requirements associated with 5010 and ICD-10.
- Specific knowledge of claims, enrollment, and /or authorizations.
- Knowledge of EDI claims management platforms
- Experience with Microsoft SQL Server or PostGREsql databases including writing queries
- Communicate clearly and professionally with internal and external customers; including the ability to explain technical detail with non-technical counterparts.
- Work effectively as part of a team to achieve established outcomes. Understand other's roles and empower one another to take responsibility to be successful. Demonstrate a collaborative interaction with peers to reach a common goal.
- Demonstrate a collaborative interaction with peers to reach a common goal as well as be a resource to team members and internal/external customers.
- Pay close attention to detail in all aspects of the job.
Posted by Adam Barron
Technical Resource Manager - Midwest
(800) 821-4644 x 9584
Technical Resource Manager - Midwest
(800) 821-4644 x 9584
