EDI Developer

Location

United States, Massachusetts, Somerville

The salary range for this position is $90,000 to $110,000 annually.

MGB Health Plan is seeking an experienced EDI Developer responsible for the design, development, implementation, and ongoing maintenance of healthcare EDI solutions supporting HIPAA transactions, including but not limited to 270/271, 276/277, 278, 820, 834, 835, 837, and 999. The ideal candidate has a strong understanding of HIPAA EDI implementation and companion guides used across the healthcare industry to ensure compliant and reliable data exchange.

The EDI Developer must have hands‑on software development experience and demonstrate the ability to follow established design principles, coding standards, and best practices. The role works closely within cross‑functional project teams, adhering to SDLC processes throughout the lifecycle of development, testing, deployment, and support.

Strong technical proficiency is required, including C#/.NET development, SQL and related tools such as SQL Server Management Studio (SSMS), SSIS, TSQL, and experience working with Microsoft SQL Server. Experience using Visual Studio and Biz Talk Server in support of EDI and integration workflows is essential.

Experience with in healthcare payer environments is highly valued. Preferred qualifications include exposure to QNXT (claims and enrollment processing systems), ASP.NET development, and XML/XSLT programming, which support complex EDI transformations and integrations.

• Programming, including writing T‑SQL in SQL Server and SSIS packages, which support the Vendor Interfaces.
• Analyze business and system requirements, including impact analyses on existing systems, to develop systems specifications.
• In partnership with the business units, design, prepare and execute unit test plans for application upgrades and enhancements.
• General data mapping of ANSI HIPAA EDI files, including coding, translation, development, testing and deployment or EDI applications.
• Perform analysis on systems and processes to become a subject matter expert, in order to help and support the business units.
• Work with hosted vendors to accomplish SDLC objectives.
• Provide data analysis support for NHP business areas in order to assist with the business areas’ information, reporting and application development needs.
• Data analysis entails understanding the flow of data and its interdependency among QNXT core modules such as Member Enrollment, Services, Claims Processing, Provider Relations, Clinical Systems and Finance.
• Track and monitor problem tickets to ensure timely resolution.
• Communicate status and elevate issues as needed.
• Identify and resolve problems related to business processes and applications.
• Coordinate and/or perform change and revision management to ensure inter‑operability of systems.
• Anticipate and meet, or exceed, internal and/or external customer expectations and requirements; establish and maintain effective relationships with customers and gain their trust and respect.
• Assist in requirements gathering with end users to clearly define information needs and translate those requirements into specifications for development.
• Participate in change management, disaster recovery and production support operations.
• Coordinate technical support and software upgrades with in‑house staff and outside vendors to ensure NHP applications are performing effectively.

• Bachelor's Degree required (relevant experience can be considered in lieu of a degree).

• Applications development experience required.
• At least 3‑5 years of experience in application development, support and maintenance in a dynamic, Microsoft environment. Healthcare systems related experience preferred.
• Experience with QNXT and CCA or other Integrated Health Care Systems - ASP.NET, C# and SharePoint Applications preferred.
• Experience required in SSIS packages, ANSI X12, XML, HL7 formatted EDI transactions preferred.

• Understanding of the data dependencies that exist between applications and systems.
• Experience with the development and support of intra‑application data exchanges, job…