***Mode of Interview:- In-person Interview Only (Face to Face Interview) *** Very long term project (expect to go for 4+ years) Hybrid (3days per week Onsite ) at Indianapolis -IN Possible contract to hire; customer does not sponsor
Job Description: EDI Expert
The EDI Expert is responsible for maintaining the life cycle of claims as they arrive from health providers at IDOH, 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 transactions
- Identify incompletely documented claims processing and EDI processes, and document them
- Work with development team as a SME as Client''s ACAPS system is rewritten in .Net
- Act as liaison between OTC team and the Children''s program area on claims processing issues
- Work 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 systems
- Ensure 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''sCSHCS system
- Assist in onboarding new providers
- Assist in onboarding new clearinghouses
- Ability to work independently with less guidance and work with Client''s externals partners as needed
Skills/Requirements:-
- Bachelor’s Degree in Computer Science or related fields with IT experience Required
- Database knowledge Required 5 Years
- Understanding EDI file formats (835, 837, 210) Required 5 Years
- Knowledge of HIPAA regulations Required
- Ability to solve complex troubleshooting issues Required
- Excellent verbal and written communication skills Required
- Health Industry experience Highly desired
- Knowledge of IBM Websphere (WTX) Highly desired
- Database/SQL experience Highly desired
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