DHHS- IT Lead EDI Specialist

Lead EDI Specialist / Tester

NC Dept of Health and Human Services (DHHS) is seeking a Lead EDI Specialist to perform work related to support the Managed Care Transition Project and 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.

• 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 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.

Required/Desired

Skills:

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 - 0

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 - 0

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

- Desired - 0

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 - 0