Lead Edifecs resource
Role: Lead Edifecs resource Location: Remote Type: Contract Key Responsibilities: Support and monitor HIPAA EDI transactions including 837, 835, 834, 270/271, 276/277, and 278 using Edifecs tools in a Health Plan environment Troubleshoot EDI production issues, analyze rejected transactions, perform root cause analysis, and coordinate issue resolution with internal and external teams Configure, maintain, and support Edifecs applications including XEngine, SpecBuilder, Transaction Management, and Smart Trading for inbound and outbound transaction processing Collaborate with business users, providers, clearinghouses, and trading partners for EDI onboarding, connectivity setup, testing, and implementation activities Perform HIPAA compliance validation and support testing efforts including unit testing, integration testing, regression testing, and UAT for EDI enhancements and implementations Utilize SQL queries and healthcare data analysis techniques to investigate claims, enrollment, eligibility, and encounter processing issues Work closely with claims, enrollment, provider management, and infrastructure teams to support daily operations and project initiatives Create and maintain technical documentation including mapping documents, process flows, functional specifications, and production support procedures Monitor EDI transaction workflows, batch jobs, and system alerts to ensure SLA compliance and uninterrupted data processing Participate in release deployments, system upgrades, and ongoing maintenance activities within the Edifecs and EDI environment Basic Qualifications: (what are the skills required to this job with minimum years of experience on each) Minimum 5+ years of experience working in Healthcare EDI and HIPAA transaction processing within a Health Plan or Healthcare environment Minimum 3+ years of hands-on experience with Edifecs tools such as XEngine, SpecBuilder, Transaction Management, and Smart Trading Minimum 3+ years of experience supporting HIPAA X12 transactions including 837, 835, 834, 270/271, and 276/277 Minimum 2+ years of experience troubleshooting EDI production support issues and performing root cause analysis Minimum 2+ years of experience working with SQL for healthcare data analysis, validation, and issue investigation Experience with trading partner onboarding, EDI connectivity protocols such as SFTP/AS2, and compliance testing activities Strong understanding of healthcare claims processing, enrollment, eligibility, and encounter management workflows Experience working with incident management and ticketing tools such as Jira or ServiceNow Travel: This position may require occasional travel based on project and business needs. Degree: Bachelor’s degree in Computer Science, Information Systems, Healthcare Informatics, or equivalent work experience Nice to Have; (But not a must) Experience supporting Medicare, Medicaid, or Commercial Health Plan operations Project lead or offshore/onshore coordination experience Knowledge of XML, XSD, and EDI mapping concepts Experience working in Agile development and support environments