HYBRID Senior EDI Developer 795706
Must be a resident in Indianapolis, IN. Short Description: We are seeking an EDI expert in order to maintain and advance our client's health insurance claims processing system. Complete Description: The EDI Expert is responsible for maintaining the life cycle of claims as they arrive from health providers, 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 transactionsIdentify incompletely documented claims processing and EDI processes, and document themWork with development team as a SME as client's health insurance claims system is rewritten in .NetAct as liaison between OTC team and the Children's program area on claims processing issuesWorking 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 systemsEnsure 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 systemAssist in onboarding new providersAssist in onboarding new clearinghousesAbility to work independently with little guidance and work with externals partners as needed.Requirements:Bachelor's Degree in Computer Science or related fields with IT experience5 years' experience with database knowledge5 years' experience understanding EDI file formats (835, 837, 210)Knowledge of HIPAA regulationsAbility to solve complex troubleshooting issuesExcellent verbal and written communication skillsPreferred skills:Health industry experienceKnowledge of IBM Websphere (WTX)Database/SQL experience