Job Title: Payer EDI Subject Matter Expert
Job Type: Full-time / Contract
Location: Remote, U.S. / Eastern Time availability required
Clearance: Ability to obtain and maintain a Public Trust clearance
Start Date: On or around September 1, 2026
Position Status: Contingent upon contract award
About the Role
We are seeking a Payer EDI Subject Matter Expert to support a federal healthcare modernization program involving payer/provider transactions, eligibility, claims, enrollment, pharmacy, Companion Guides, business rules, and technical documentation.
The ideal candidate has hands-on experience with healthcare EDI standards, including X12, NCPDP, TR3s, Companion Guides, payer/provider workflows, claims transactions, eligibility transactions, and EDI compliance documentation. This role will work closely with business analysts, architects, developers, testers, and federal healthcare stakeholders to translate EDI requirements into functional documentation, business rules, process flows, and implementation support materials.
Key Responsibilities
- Provide subject matter expertise for payer EDI requirements, transactions, standards, and documentation.
- Analyze and interpret X12, NCPDP, TR3, Companion Guide, and payer/provider transaction requirements.
- Support development of business rules tied to EDI compliance and transaction processing.
- Create and review BRDs, functional requirements, use cases, user stories, SOPs, process flows, context diagrams, and technical documentation.
- Support claims, eligibility, enrollment, provider, pharmacy, payer, and beneficiary workflow analysis.
- Collaborate with technical teams on data mapping, transaction validation, EDI integration, and defect resolution.
- Support issue tracking, defect triage, root cause analysis, and resolution planning.
- Participate in stakeholder meetings, requirements sessions, testing activities, and implementation readiness reviews.
- Ensure documentation and recommendations align with federal healthcare security, privacy, PII/PHI, and compliance expectations.
Required Qualifications
- 5+ years of healthcare EDI experience.
- Experience with X12 healthcare transactions.
- Experience with NCPDP standards.
- Experience using TR3s and Companion Guides.
- Experience with claims, eligibility, enrollment, pharmacy, provider, payer, or beneficiary operations.
- Experience developing BRDs, functional requirements, business rules, process flows, SOPs, use cases, user stories, or context diagrams.
- Strong ability to translate technical EDI requirements into business-friendly documentation.
- Experience supporting defect tracking, issue resolution, testing, or implementation support.
- Ability to obtain and maintain a federal Public Trust clearance.
Preferred Qualifications
- Prior VA, VHA, IVC, CMS, DHA, HHS, TRICARE, Medicaid/Medicare, or federal healthcare experience.
- Experience with payer claims adjudication systems.
- Experience with eligibility verification or benefits processing.
- Experience with Visio, Jira, Azure DevOps, SharePoint, Confluence, SQL, or EDI validation tools.
- Experience supporting modernization, data integration, or cloud-enabled healthcare systems.
Pay: $31.58 - $38.03 per hour
Work Location: Remote
