Location: US-Spring Field, MA.
Health EDI ANSI X12, XML Schema, ETL&EDI toolsets, SQL, Management Studio,
Health insurance experience Expert in EDI standards and implementation
Deep EDI ANSI X12 knowledge
Good knowledge of web services, XML and defining schemas using DTD/XSD
Perform EDI mapping and end to end test
Hands on experience in SQL Server / relational databases
Extensive experience integrating standard X12 transactions (834, 837, 835, 820, 270, 271, 276, 277) into internal and external systems
Experience in implementing EDI/ETL processes
Experience with various EDI and ETL toolsets
Experience with XML, X12 EDI Standards and Transactions, etc.
Experience with health care insurance or health care vendor organizations desirable
Analyze EDI and data integration/transformation requirements from business partners and develop processes to meet these requirements
Ensure data integration design and implementation is in accordance with other design components and meets end-state requirements
Apply business rules used to govern data transformations based on upstream and downstream data impact
Perform EDI system testing and quality control checks
Resolve code defects discovered during testing and implement corrective solutions
Review and correct daily errors for inbound EDI transactions and retransmit outbound EDI documents
Evaluate user requests for new and modified EDI applications, programs, processes, and maps
Manipulate data sets as needed for testing, correction, or knowledge building
Implement, maintain, and monitor EDI systems
Develop data integration components including EDI, data mapping, translation and interface
Review X12 files for issues including but not limited to: balancing, structure, syntactical, data type and content errors; then develop and execute strategies to solve them.
Troubleshooting activities include querying database using SQL Management Studio to review stored values and/or using a text editor to manually review data files sent by Payer clients
Support Payer and Provider client implementation activities by generating 835s files, reviewing their content and then presenting findings to clients/departments
Respond to inquiries regarding issues, claims, payments, and/or clearinghouse activities
Work closely with other departments on communication issues related to customer and third-party vendor connectivity
Communicate with vendor contacts to identify file issues and then disseminate the resolutions to the provider or payer
Maintain compliance with all HIPAA and general data security standards
Excellent analytical and problem solving skills.
Understanding of complex information and requirements.
Ability to explain complex systems in simple terms.
An ability to work to tight deadlines and within constraints.
Excellent customer service skills
Excellent oral and written communication skills
Excellent ability to work alone and as a team membe
Note - Duplicate of RF02034
APPS NICHE SKILLS - EAI-EDI