EDI Developer

Description

Works with Executives, Management, Staff, or Business representatives, to identify and document complex business concepts or processing conflicts; may work under the direction of a Project Manager or a Senior EDI Analyst.
Provides formal user education with software productivity and technical tools such as SSRS, SSIS, SharePoint, Microsoft Office, Visio, Team Foundation Server, or automation tools to document business and technical process requirements related to a technology system.
Comprehends, analyzes, and documents business or process requirements using personal interviews, document analysis, meetings, surveys, process documents, or actual scenarios.
Analyzes and documents functional business environments that facilitate work throughout the company.
Develops complex business requirements and specifications through internal and external research to complete technical analysis and articulate and formally present research to various skill levels.
Facilitates business meetings leveraging the Agile process to assist business units in the “What” session to ensure the creation and documentation of stories and acceptance criteria.
Provides technical interpretation to other technical teams in the Agile “How” session to understand technical requirements related to the business stories and acceptance criteria.
Effectively communicates and collaborates with internal and external customers in support of analytics or problem resolution.
Analyzes and evaluates information gathered from multiple sources to resolve reconciliation conflicts.
Comprehends and implements system configuration changes of the managed care core system software to process data transactions for business functions such as eligibility, claims, authorizations, and case management.
Designs, develops, and/or assists in the testing and implementation of software systems used by the organization.
Identifies and creates personal process checklists that will be used to process HPSJ programs and applications to support departmental activities.
May assume the duties of a Project Manager for medium to large-sized projects using standard PMBOK processes to identify scope, requirements, resources, and stakeholders using standard analysis techniques.
Lead and mentor in areas that need cross-training and independently provide knowledge and documentation exchange to educate team members in Analytical roles in support of team redundancy.

Responsibilities

• In-depth knowledge of and ability to apply the American National Standards Institute (ANSI) formats that govern healthcare Electronic Data Interchange (EDI).
• Must have at least four (4) years of experience developing and maintaining Healthcare EDI X12N transactions, including batch and real-time formats such as: 837I/837P, 274, 834, 835, 270/271.
• Requires at least two (2) years of Edifecs hands-on experience with Healthcare EDI X12N transactions, including analytics, mapping, developing, testing, and deployment.
• Has experience with HL-7 and NCPDP File Formats, QNXT Healthcare Core Systems, including knowledge of QNXT EDI Manager and QNXT Connect (MS BizTalk).
• Advanced knowledge of and ability to apply SDLC (Software Development Life Cycle) and Agile Scrum Methodologies.
• Successfully engage in multiple complex initiatives simultaneously forms of electronic resources in everyday communications.
• Proficient with the structure query language (SQL) for analytical data mining, software development, TFS, and business reporting.
• In-depth knowledge and understanding of medical terminology to include ICD, CPT, and HCPCS coding systems related to encounters and
• 837s. Strong oral and written communication skills, with the ability to effectively communicate complex technical issues in terms clearly understood by technical and non-technical audiences and write technical specifications.
• Interpersonal skills - interacts effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people.
• Effectively communicate and collaborate with internal and external customers in support of analytics or problem resolution.
• Strong listening skills, with the ability to accurately receive and understand messages.
• Strong problem solving and analytical skills, with ability to determine key issues, develop effective action plans.
• Comprehensive understanding of the various department technological resources and their roles in order to utilize various implement successful conclusions.
• Produces work that is accurate and complete.
• Produces the appropriate amount of work.
• Actively learns through experimentation when tackling new problems, using both successes and failures to learn.
• Rebounds from setbacks and adversity when facing difficult situations.
• Knows the most effective and efficient process to get things done, with a focus on continuous improvement.
• Demonstrates a commitment to HPSJ’s strategy, vision, mission, and values.
• Time management and organizational skills. Uses time effectively and efficiently. Values time. Concentrates his/her efforts on the more important priorities. Can attend to a broader range of activities. Meets deadlines.
• Ability to work independently and as part of a team.
• Basic mathematics skills.
• Strong skills in Windows, Excel, Word, Outlook, and Visio.
• Ability to speak and be understood in English.