EDI Tester with X12, 837/277CA/834/TA1/999/820/NCPDP, HIPAA, agile and medicaid/MMIS/healthcare claims processing experience

Job ID: NC-585264 (96190123)

EDI Tester with X12, 837/277CA/834/TA1/999/820/NCPDP, HIPAA, agile and medicaid/MMIS/healthcare claims processing experience

Location: Raleigh NC (DHHS)
Duration: 12 months
Interview: In-person or webcam
Positions: 1 (1/2)

Skill Required / Desired Amount of Experience
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
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
Excellent verbal and written communication skills with the ability present to both technical and business audiences. Desired
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

NC Dept of Health and Human Services (DHHS) is seeking a Lead EDI Specialist to perform work related to to support 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
Develop and execute test scripts related to X12 Transmission
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 matter
• 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

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