Summary:
We are expanding our Encounter Development team and seeking a Healthcare EDI Developer to support enterprise encounter reporting through timely, accurate generation and submission of 837D X12 encounter files.
Job Responsibilities
• Execute recurring operational tasks to generate encounter data files; monitor daily production jobs, troubleshoot issues, and drive error investigation through resolution. • Design, build, and maintain X12 EDI 837 encounter processing workflows. • Ensure solutions comply with HIPAA and X12 standards, including state- and client-specific implementation guides. • Perform unit, integration, and regression testing for EDI processes and related data flows. • Interpret and reconcile 999, 277, 835, and custom state/client response files associated with encounter submissions.
• Develop and maintain data mappings between internal application data models and EDI segments/loops. • Implement corrective actions to remediate defects and reduce or eliminate repeat issues. • Partner with external clients and internal operational teams on new client implementations and changes to existing submissions. • Create and execute EDI test plans and provide clear, timely status updates to internal stakeholders and clients.
Experience and Qualifications
• 3+ years of relevant experience in the healthcare industry, Dental preferred • 3+ years of experience in a data analyst role, preferably supporting healthcare EDI. • 1+ years of experience developing post-adjudication X12 837 files (required). • 1+ years of SQL experience. • Working knowledge of HIPAA X12 standards, specifically the 837 claim/encounter transaction. • Strong attention to detail with the ability to analyze client needs and accurately document processes. • Excellent analytical, troubleshooting, and communication skills.
• Experience with IBM Sterling B2B Integrator is preferred.
