EDI Lead​/Senior EDI Specialist

Job title: IT Lead EDI Specialist

Location: Raleigh, NC

Duration: 6 Months

Need local candidates only

NC Department of Health and Human Services (DHHS) is seeking a Lead EDI Specialist / Tester to perform work related to support the Managed Care Transition Project and 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.
• Conduct QA and testing on EDI applications.
• 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 manner.
• 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 through 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.

• 7 Years expert in developing and executing test scripts related to X12 EDI Transmission.
• 5 Years demonstrated proficiency in conducting QA and testing on EDI applications.
• 5 Years expert in EDI mapping for 837, 277CA, 834, 835, TA1, 999, 820, NCPDP
  
  D.0.
• 5 Years high degree of business and technical knowledge with significant practical experience in HIPAA X12 EDI Transactions.
• 2 Years' experience setting up users/new Trading Partner relationship/Standards/Envelope and full cycle testing.
• 3 Years' experience in creating and managing catalog of EDI document types such as 837, 277CA, 834, 835, TA1, 999, 820, NCPDP
  
  D.0.
• 3 Years proven experience in processing and monitoring all inbound and outbound X12 transactions.
• 2 Years knowledge of Agile Methodology.
• 2 Years' experience in collaborating with EDI partners to resolve transmission problems.

• Strong understanding of healthcare claims processing - Claims, Provider, Eligibility.
• Working knowledge of Medicaid and/or MMIS.

• Excellent verbal and written communication skills with the ability to present to both technical and business audiences.