EDI Developer

Job Description

X12 Developer

Role Overview / What This Role Does This role is responsible for designing, supporting, and maintaining a large scale healthcare billing and eligibility platform that processes Medicaid and commercial insurance transactions across multiple states.
The developer will own end?to?end billing workflows-including eligibility, claim submission, remittance processing, escrow and recoupment logic, and corrections-ensuring claims are accurate, compliant, and paid correctly.
The developer will work heavily in backend integration services, SQL Server stored procedures, and batch processing systems, troubleshooting complex production issues, implementing payer? and state?specific business rules, and performing data corrections when needed.
This role requires close collaboration with billing operations, data teams, and compliance stakeholders to translate policy and reimbursement rules into reliable system behavior.
Success in this role means keeping mission critical billing processes running, resolving production issues quickly and safely, preventing duplicate or incorrect claims, and continuously improving the stability, performance, and correctness of a business critical system.

Key Responsibilities & Required Skills Healthcare Billing & EDI Expertise

• Deep experience with HIPAA X12 transactions: 270/271 (Eligibility), 276/277 (Claim Status), 837P/I (Claims), 835 (Remittance), 999/TA1 acknowledgements
• Strong understanding of Medicaid and commercial insurance billing workflows, including Primary vs secondary claims, Escrow and recoupment logic, voids, corrections, rebills, sweeps, denials, and adjustments
• Understanding of Healthcare revenue & claims life cycle including, escrow, takebacks, over payments, rate corrections, voids, corrections, rebills, sweeps, and reprocessing
• Ability to debug payer specific rules and state specific Medicaid behaviors

Backend Development & Database Engineering

• Advanced SQL Server skills including writing, debugging, and optimizing complex stored procedures, diagnosing stuck records, data corrections, backfills, and one time cleanup scripts in production
• Experience maintaining batch oriented and transaction oriented processing systems

Integration & File Processing

• Design and support SFTP based inbound/outbound integrations for large flat files (837/835, eligibility feeds, daily ETLs)
• Build and maintain high volume, batch oriented, file based processing workflows
• Implement resilient import pipelines with error handling, retry logic, alerting, and recovery mechanisms

Cloud & Platform Skills

• Experience operating production systems in AWS
• Comfort working in mixed legacy + modern environments

Production Support & Incident Management

• Proven ability to:
  • Triage production issues quickly using logs, data analysis, and job history
  • Identify root causes across application code, stored procedures, and data
  • Execute fixes under production pressure
• Experience responding to recurring system alerts and eliminating root causes
• Diagnosing job timing, retries, late files, partial runs

Business Logic & Rules Engines

• Implement and maintain complex validation/edit logic
• Translate policy changes into code and data changes
• Strong attention to reporting, financial accuracy and audit readiness
• Design and support configurable solutions to accommodate varying state rules

Professional Skills

• Comfortable working with domain experts (billing, compliance, operations)
• Writes clear, auditable SQL and application logic
• Documents decisions and understands regulatory impact

Required Technical Skills .NET Development

• C# development with .NET Core 6/8/10, .NET Framework 4.8, and ASP.NET Web Forms
• EDI/X12 processing using Edi Fabric or equivalent EDI toolkits
• X12 transaction pipelines (837, 835, eligibility, acknowledgments)
• Secure application development including PII/PHI handling (HIPAA) and role based access
• Configuration driven architecture separating code from environment, client, and state/agency rules

Database & Data Engineering

• SQL Server 2019+
• Advanced TSQL (complex queries, data modification, performance optimization)
• SSIS package maintenance and tuning
• Stored procedures, views, and database security
• Data analysis across highly configurable schemas
• Database deployment and release scripting

ORM & Data Access

• Entity Framework
• LINQ query composition
• DbContext lifecycle and performance management

Application Quality & Performance

• Debugging and root cause analysis
• Ability to identify, refactor, and improve poorly performing code
• Application and database performance tuning
• Code refactoring for maintainability and scalability
• Unit testing for new and existing functionality

Source Control & Dev Ops

• Git (branching strategies, pull requests, code reviews)
• Azure Dev Ops (pipelines, work items, repositories)

Configuration & Deployment

• Environment aware development and deployment patterns
• File based and database driven configuration management

Kavaliro provides Equal Employment Opportunities to all employees and applicants. All qualified applicants will receive…