Senior Electronic Data Interchange; EDI Database Programmer

Position Overview

Senior Electronic Data Interchange (EDI) Database Programmer in the Analytics and Reporting Department is responsible for managing encounter data submission to CMS (Centers for Medicare and Medicaid Services) and other regulatory entities as required. This role includes troubleshooting EDI mapping issues, resolving encounter data reporting errors, monitoring CMS Encounter Data Quality reports such as MAO
002 and MAO
003, ensuring adherence to EDI standards, writing complex SQL queries and stored procedures, creating SQL Server Integration Services (SSIS) jobs for EDI file submission, and troubleshooting EDI error records. The position also involves developing and maintaining EDI documentation, including process flows, collaborating with cross‑functional teams to identify EDI problem areas, preparing test data, conditions and expected results to verify new EDI updates and logic, and building ETL for claims extracts, enrollment extracts, and supplemental extracts for Denta Quest, InComm, Modiv Care, etc.

The successful candidate must have strong SQL programming skills, EDI analytical skills, excellent communication skills, and healthcare experience with knowledge in membership, provider and claims data.

• Monitor and submit encounter data files to CMS and NYSDOH.
• Collaborate with vendors and end users to correct EDI error transactions and resubmit to CMS.
• Maintain ETL data extracts for EDPS data submissions.
• Support compliance and regulatory inquiries on encounter data processes.
• Support CMS reporting and other regulatory reporting.
• Create KPI reports on encounter data reporting.
• Create SQL stored procedures, SSIS packages, flow diagrams, and document the process for encounter data reporting.
• Develop and test EDI mapping for encounter submissions.
• Troubleshoot EDI errors using MAO
  002 and MAO
  003 reports and track all resubmissions to CMS.

• Bachelor’s degree in information systems, computer science, or database management required; master’s degree preferred.
• Minimum 10 years of programming experience in SQL Server database object development, including stored procedures, functions, views, SSIS, SSRS, X12 EDI mapping and development, and troubleshooting EDI errors.
• Minimum 5 years of experience in complex healthcare data such as claims, enrollment, and providers.
• Strong knowledge of EDI X12 standards, especially for transactions 837, 834, 277CA, 999.
• Prior experience in submitting encounters to CMS required.
• Previous experience with BI reporting tools such as Business Objects, Tableau, or Power BI.
• Knowledge of Health Edge’s Health Rule Payor (HRP) backend tables preferred.
• Knowledge of Visual Studio, .NET development, XML.

• Integrity and trust.
• Collaboration and time‑management skills.
• Functional/technical skills.
• Written and oral communication.
• Teamwork.
• Excellent analytical and problem‑solving skills.
• Ability to work effectively in a team environment and adapt to different projects and assignments quickly.