EDI Specialist
Austin, Texas
6 Months
Job :
The EDI Specialist II will work with trading partners to ensure timely and accurate posting of all responses to claim submission, eligibility request, claim status request and remits, while continuously improving the department processes and procedures to ensure the highest value possible for FirstCare health Plans customers. Responsible for developing, testing and implementing EDI processes and will function as EDI expert assisting and training other EDI Production team members.
ESSENTIAL DUTIES and RESPONSIBILITIES:
• Analyze, design, develop, test, troubleshoot, optimize, enhance and maintain EDI applications in various formats that include HIPAA standard formats such as 837 and 834, 837, 835, 277CA and other proprietary formats using EDI mapping tools.
• Create and maintain interfaces between applications systems and client EDI transactions.
• Apply in-depth knowledge of systems and business to the development
of technical design for large complex processes and projects.
• Evaluate user requests for new and modifications to applications/programs/processes/maps.
• Maintain detailed documentation and process flow of all EDI processes.
• Communicate with trading partners, software vendors, and internal departments.
• Conduct research and make recommendations on ETL products, services, protocols, and standards in support of procurement and development efforts.
• Participate in project meetings, providing input to project plans and providing status updates.
• At the request of end users or management, research questions involving EDI applications and how the data is organized and populated.
• Provide status updates on all assigned tasks using the department's service request tracking tool.
• Support end-user functional departments as requested by management.
• Follow existing source code management and version control processes for all coding efforts.
Requirements EDUCATION and/or EXPERIENCE:
• Bachelor's degree (B. A.) from four-year college or university
• 3 - 5 years experience with advanced knowledge of EDI standards, documents, and software, such as Pervasive ETL tools.
• Clear understanding & working knowledge of HIPAA EDI protocols.
• Able to generate HIPAA transactions using mapping application tool and data from claims payable system.
• 2 years experience in health care industry with proven understanding of data terminology.
• Exposure and general understanding of Healthcare claims processing.
• Clear understanding of RDBMS systems, Web Transactions, and MS SQL Server 2008
Alok Kumar
|Dynamic Software Services, Inc.|
766 Sutter Street -13.San Francisco, CA- 94109|
Office: 4152595570| Fax: 415-520-5437| alok@dyssinc.com
IM---kumaralok.recruiter
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