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 IDOH’s ACAPS system is rewritten in .Net
• Act as liaison between OTC team and the Children’s program area on claims processing issues
• Working 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.
o Provide support to healthcare providers who interact with IDOH’s CSHCS system
o Assist in onboarding new providers
o Assist in onboarding new clearinghouses
• Ability to work independently with less guidance and work with ISDH externals partners as needed.
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