Role: DHHS- IT Lead EDI Specialist (803026)
Location: Raleigh, NC (Hybrid)
Duration: 12 Months
Interview Mode: Webcam Interview
Description:
NC Dept of Health and Human Services (DHHS) is seeking a Lead EDI Specialist / Tester to perform work related to support the Managed Care Transition Project.
Developer Job Summary:
NC Dept of Health and Human Services (DHHS) is seeking a Lead EDI Specialist to perform work related to to support the Medicaid Reform Project.
This position is responsible for the following activities related to a critical system being developed in-house at the State:
• High degree of business and technical knowledge with significant practical experience in HIPAA X12 EDI Transactions.
• Expert in EDI mapping for 837, 277CA, 834, 835, TA1, 999, 820, NCPDP D.0
• Develop and execute test scripts related to X12 Transmission
Conducts QA and Testing on EDI applications
Develop and execute Test scripts related to X12 Transmission
Experience setting up users/new Trading Partner relationship/Standards/Envelope and full cycle testing
• Provides technical support during and after implementation for healthcare electronic data interchange applications
• Responds to inquiries regarding EDI issues with encounter claims and trading partner activities
• Management of catalog of EDI document types such as 837, 277CA, 834, 835, TA1, 999, 820, NCPDP D.0
• Communication between Trading Partners and department
• Maintain detailed documentation and process flow of all EDI processes
• Identify and facilitate issues with partner data mapping from onset through completion
• Process and monitor all inbound and outbound X12 transactions
• Support Customer Service group with EDI related issues
• Identifies, recommends and implements process improvements in support of the EDI system
• Troubleshoot EDI document processing errors and work with trading partners directly to resolve in a timely matter
• Conducts analysis of EDI transactions and is responsible for documentation and reports
• Collaborate with EDI partners to resolve transmission problems.
• Track day-to-day EDI & batch processes to identify and address problems as they arise reporting levels of activity using key established metrics for senior management
• Effectively communicate issues and needs with internal business partners, external vendors, and healthcare providers
• Develops and maintains cross walking and validation rules for file exchanges
• Triages incoming EDI issues thru monitoring
•
• Ability to communicate effectively with technical and business staff
• Support internal resources to resolve issues, answer questions, and retransmit EDI documents when necessary
• Work with end users to ensure user acceptance testing is thorough and complete
• • Employees should be able to work independently with minimal supervision.
• Knowledge of Agile Methodology
|
Skill
|
Required / Desired
|
Amount
|
of Experience
|
|
Expert in developing and executing test scripts related to X12 EDI Transmission
|
Required
|
7
|
Years
|
|
Demonstrated proficiency in conducting QA and testing on EDI applications
|
Required
|
5
|
Years
|
|
Expert in EDI mapping for 837, 277CA, 834, 835, TA1, 999, 820, NCPDP D.0
|
Required
|
5
|
Years
|
|
High degree of business and technical knowledge with significant practical experience in HIPAA X12 EDI Transactions.
|
Required
|
5
|
Years
|
|
Strong understanding of healthcare claims processing - Claims, Provider, Eligibility
|
Highly desired
|
|
|
|
Experience setting up users/new Trading Partner relationship/Standards/Envelope and full cycle testing
|
Required
|
2
|
Years
|
|
Experience in creating and managing catalog of EDI document types such as 837, 277CA, 834, 835, TA1, 999, 820, NCPDP D.0
|
Required
|
3
|
Years
|
|
Working knowledge of Medicaid and/or MMIS
|
Highly desired
|
|
|
|
Excellent verbal and written communication skills with the ability present to both technical and business audiences.
|
Desired
|
|
|
|
Proven experience in processing and monitoring all inbound and outbound X12 transactions
|
Required
|
3
|
Years
|
|
Knowledge of Agile Methodology
|
Required
|
2
|
Years
|
|
Experience in collaborating with EDI partners to resolve transmission problems.
|
Required
|
2
|
Years
|
|
LOCAL candidates only
|
Required
|
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