Scope and Purpose of Position
The Programmer Analysts is responsible for the development, testing, internal production, and support process related and ensuring the timely and accurate processing of 834 and Custom enrollment files submitted by the Health plan and Clearinghouses.
- Responsible for the implementation of HIPAA EDI 5010 X12 834 and providing translation summary report for feedback to trading partners.
- Develop eligibility reconciliation reports and ensuring that all required member attributes are mapped in the system.
- Configure and maintain trading partners' EDI profiles in the system.
- Responsible for supporting and testing HIPAA EDI 5010 X12 834 mapping formats as well as other industry standard and custom formats.
- Responds to inquiries regarding EDI issues with enrollment. Conducts analysis of EDI transactions and is responsible for documentation and reports.
- Accountable for importing, validating and reporting data into database or exporting data from the database into appropriate EDI formats to support business processes and trading partner's requirements.
- Own and manage the development of ongoing implementations start to finish from client meeting and ANSX12 5010 companion guide review, through internal testing process, development and deploy into production with documentation.
- Manage day-to-day production file monitoring for complex 834 EDI file processing including troubleshooting and error investigation.
- Design and execute EDI test plans. Provide timely communication amongst clients on a daily/weekly/monthly basis as well as ad-hoc.
Education & Experience
- Minimum of 3-4 years' experience in EasyTrieve programming is required.
- Minimum of 3-5 years relevant work experience in managed health care is preferred.
- Minimum of 3-5 years' experience in EDI Programmer/Analyst role in healthcare claims, adjudication systems/environments is required.
- Comprehensive knowledge of HIPAA EDI 5010 X12 834 transaction, including detailed understanding of all relevant loops and file structures is required.
- Experience with Mainframe CICS desired
- Experience utilizing Axway Sentinel desired
- Experience in implementation of control and reconciliation reports.
- Experience working with EDI validators.
- Knowledgeable in writing PL/SQL queries in Oracle or SQL Server.
- Analytical, problem resolution and people skills.
- Attention to detail
- Critical evaluation/thinking
- Customer/client service focused
- Decision making
- Problem solving/analysis
If you are prohibited from working on a government contract, this may disqualify you from consideration for this position.