Note: The job is a remote job and is open to candidates in USA. EDI Staffing, an EDI Specialists Company, is seeking a Healthcare EDI SQL/SSIS Developer / Claims EDI Operations Specialist to manage the technical and administrative lifecycle of healthcare claims data. The role oversees EDI transaction processing, SQL and SSIS workflows, data validation, trading-partner support, implementation testing, reporting, automation monitoring, and claims process improvement.
Responsibilities
- Manage the end-to-end lifecycle of EDI transactions (834/835/837), including file programming, validation, output, and error resolution
- Serve as the primary liaison for trading partners, clearinghouses, payers, and vendors to troubleshoot transmission failures and rejection codes
- Manage file generation and uploads and ensure compliance with x12 formatting standards
- Research, analyze, and resolve data discrepancies between output files and source systems
- Validate file layouts and mappings, against companion guide requirements
- Ensure strict compliance with HIPAA x12 standards, CMS guidelines, and internal data policies
- Lead testing and validation for new trading partner implementations or system upgrades
- Document business requirements for implementations, system enhancements, or new trading partners
- Monitor post-go-live implementations for data accuracy and coordinate required corrections
- Develop and maintain comprehensive desktop procedures, job aids, and EOP insert revisions for new or changed processes
- Develop testing schedules and accountabilities, documenting results and lessons learned
- Perform time studies within the claims department to identify bottlenecks and document process steps
- Act as the liaison between Reporting/Data Analytics and Claims Management to drive reporting enhancements
- Maintain and distribute Claims Dashboards (Trends/Patterns) by the 5th of the month
- Develop and maintain GURU Claims Dashboard and Cards; generate reporting on usage and ROI
- Oversee Symkey Daily Robot Checks and monitor automation performance
- Train Claims Staff on Standard Policies and Procedures regarding data handling
- Maintain Desktop Procedures for Payor Audits
- Distribute operational reports to internal and external stakeholders
Skills
- 3+ years of EDI experience specifically with 834 (Enrollment), 835 (Remittance), or 837 (Claim) transactions required
- 3-5 years Medicare/Medicaid claims experience required
- Advanced proficiency in Microsoft Excel (VLOOKUP's, pivots)
- Proficiency of SQL and database querying
- Develop and maintain complex SQL queries, stored procedures, views, and data transformations using Microsoft SQL Server
- Develop, maintain, and troubleshoot SSIS packages supporting ETL, claims processing, and EDI workflows
- Trace data from source systems through SQL/SSIS processes to final EDI output and identify data discrepancies or processing issues
- Excellent data analysis skills with the ability to review data to identify trends, anomalies, and opportunities
- Excellent oral and written communication skills; capable of explaining technical issues to non-technical stakeholders
- Highly self-motivated and capable of working independently to follow issues through to conclusion
- Detail-oriented with the ability to prioritize tasks in a fast-paced environment
- Ability to maintain a high level of confidentiality and remain HIPAA compliant
- Ability to multitask in a fast-paced work environment
- Ability to remain calm under pressure and manage stressful situations
- Ability to establish highly productive and detailed organizational skills/habits
- Ability to actively listen and solve problems with cooperation, assertiveness, and flexibility for positive outcomes
- Possess strong, professional written and oral communication skills for in-person, telephonic, and electronic use
- Associate's or bachelor's degree in healthcare administration, Information Technology, or related field preferred (or equivalent technical experience)
Benefits
- Full-time, remote work arrangement
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