Description A growing organization is seeking a
Senior Healthcare Integration Specialist to take ownership of critical data connections supporting claims administration and related business operations. This individual will serve as the primary point of coordination between external partners, internal stakeholders, and technical resources to ensure information is exchanged accurately, securely, and according to established timelines.
This is a hands-on individual contributor role for someone who understands healthcare transaction processing and can independently manage partner requirements, connection setup, testing, production support, and ongoing issue resolution.
Key Responsibilities
- Own the operational lifecycle of electronic integrations, from initial requirements gathering and connectivity setup through testing, launch, and ongoing support.
- Coordinate with external partners to establish transmission requirements, delivery schedules, file-naming conventions, security protocols, and processing expectations.
- Support healthcare claims transactions, with an emphasis on 837 files, while providing additional assistance across related enrollment, eligibility, payment, and authorization exchanges.
- Configure and maintain secure file-transfer connections, including SFTP-based exchanges between external organizations and internal environments.
- Monitor inbound and outbound activity to identify missing files, processing delays, rejected transactions, connection failures, and formatting discrepancies.
- Research transaction errors and collaborate with the appropriate business, development, database, or partner resources to reach resolution.
- Review electronic files and transaction structures to validate that data aligns with agreed-upon specifications and business requirements.
- Coordinate implementation activities with vendors, service providers, and other external organizations exchanging business-critical information.
- Maintain documentation for partner requirements, transmission schedules, support procedures, recurring processes, and configuration details.
- Provide subject-matter guidance to internal teams while helping improve the consistency, visibility, and reliability of integration processes.
- Participate in technology changes, partner transitions, system enhancements, and other projects that affect electronic information exchange.
Requirements Bachelor's degree in information technology or a related discipline, or equivalent practical experience.
At least 7 years of experience working with EDI in a technical or analyst capacity.
Strong working knowledge of healthcare EDI transactions, including 837, 835, 270/271, and 278.
Experience supporting ANSI X12-based exchanges and related data formats such as XML and JSON.
Background managing external relationships with clearinghouses, vendors, third-party administrators, or trading partners.
Proven ability to troubleshoot transaction failures, investigate data quality issues, and support production environments.
Strong analytical thinking, organization, and problem-solving skills with the ability to manage multiple priorities.
Effective written and verbal communication skills for collaborating with both technical teams and business stakeholders.Required Qualifications
- Bachelor's degree or equivalent combination of education and relevant professional experience.
- Seven or more years of experience supporting EDI, healthcare integrations, data exchange, claims technology, or a closely related function.
- Working knowledge of ANSI X12 standards and healthcare transaction processing.
- Hands-on experience supporting 837 claims transactions and resolving related processing or transmission issues.
- Experience gathering integration requirements and coordinating directly with external trading partners or service providers.
- Familiarity with secure file-transfer methods, including SFTP, connection setup, file routing, and transmission monitoring.
- Ability to interpret structured data formats and troubleshoot discrepancies across multiple systems.
- Strong documentation, follow-through, and cross-functional communication skills.
- Ability to manage critical integration activity independently without direct reports.
Preferred Experience
- Background within a health plan, healthcare administrator, clearinghouse, healthcare technology provider, or revenue cycle organization.
- Familiarity with additional healthcare transactions such as 834, 835, 270/271, or 278.
- Exposure to flat files, XML, JSON, APIs, or other data-exchange methods.
- Experience supporting partner onboarding, certification testing, production validation, and ongoing integration maintenance.
- Understanding of claims, eligibility, enrollment, remittance, or healthcare payment workflows.
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