Position Title: EDI Programmer
Job Location: Greater Boston area
Interview Expectations: onsite
Local Candidate: not required
Required Skill Sets: healthcare, HIPAA, EDI
Responsible for the design, development, maintenance and support of all Standard (HIPAA X12 and HL7) EDI and Custom (proprietary) EDI process used in the EDI infrastructure. Analyze, design, develop and maintain robust EDI processes to customize and execute EDI transaction processing for the ANSI HIPAA EDI transaction sets 834, 835, 837, 278, 999, 270/271 and 276/277 for small to large technology based projects and maintain the EDI infrastructure in Microsoft technology platforms.
- Analyzes business and system requirements, including impact analyses on existing systems, to develop design and systems specifications
- General data mapping of ANSI HIPAA EDI files 834, 835, 837, 278, 999, 270/271 and 276/277, and ANSI HL7 transaction including coding, translation, development, testing and deployment or EDI applications.
- Programming including Visual Studio, ASP.NET, C#, Microsoft BizTalk Server development for HIPAA EDI development.
- Programming, including writing T-SQL in SQL Server and SSIS packages, which support the Vendor Interfaces.
- Provides data analysis support for 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 and Services, Claims Processing, Provider Relations, Clinical Systems and Finance.
- Identifies, troubleshoots and resolves problems related to business processes and applications.
- Analyzes business and system requirements, including impact analyses on existing systems, to develop design and systems specifications.
- Tracks and monitors problem tickets to insure timely resolution.
- Reviews and analyzes system logs and Microsoft and third-party management products to preemptively detect and correct system issues. Performs capacity planning to ensure adequate availability and performance.
- Communicates status and escalates issues as needed.
- Participates in change management, disaster recovery and production support operations.
- Coordinates technical support and software upgrades with in-house staff and outside vendors to ensure applications are performing effectively.
KNOWLEDGE AND EDUCATION
Bachelor’ s Degree or the equivalent combination of training and experience, plus 3 years of related experience.
- Three to Five years relevant working experience in EDI Transactions Processing, design, development and maintenance in Microsoft technologies platform and environments.
- EDI Developer should be an experienced developer with capability of working in the teams of small to medium sized projects from technical implementation side.
- EDI Developer must understand the essential functions of the EDI processes such as processing of ANSI HIPAA 834, 835, 837, 278, 999, 270/271 and 276/277 and HL7 Transaction sets and solutions designed to consume and produce these transactions.
- EDI Developer should be capable of designing and developing EDI mapping, comprehending the Implementation and Companion Guides related to EDI transactions and exchanges.
- EDI Developer should be knowledgeable in understanding BizTalk Server and the areas of BizTalk based applications related to EDI transactions processing like maps, pipelines schemas, orchestrations etc.
- EDI Developer should be knowledgeable in understanding QNXT data model in all the critical modules like Group, Member, Provider, Claims etc.
- EDI Developer should understand the Health Insurance business applications and data model.
- EDI Developer should have knowledge in QNXT or any other Payer based enterprise solutions
- EDI Developer should be familiar with Business Analysis and System Integration related business processes.
- Demonstrated ability to develop EDI solutions, workflows, business workflows to meet business requirements
- Strong analytical, programming and demonstrated project management skills.
- Demonstrate Core Values of Accountability, Service Excellence, Quality Care, Diversity, and forging strong Relationships.
- Respect the talent and unique contribution of every individual, culture and ethnic group and treat all people in a fair and equitable manner.
- Exercise self-awareness; monitor impact on others; is receptive to and seek out feedback; use self-discipline to adjust to feedback.
- Accountable for delivering high quality work. Act with a clear sense of ownership.