Benefits:

401(k) matching

Dental insurance

Health insurance

We are seeking an experienced Lead EDI Specialist to join the Medicaid Reform Project team. This role is critical in managing electronic data interchange (EDI) processes, ensuring compliance with HIPAA standards, and delivering seamless data transactions across healthcare systems. As the Lead EDI Specialist, you will be responsible for designing, testing, implementing, and maintaining EDI processes to support effective data exchanges between trading partners and NC DHHS.

Key Responsibilities:

Utilize advanced knowledge of HIPAA X12 EDI standards and extensive experience with 837, 277CA, 834, 835, TA1, 999, 820, and NCPDP D.0 transactions.

Develop, execute, and validate EDI mapping and testing for transactions, including creating and executing test scripts related to X12 transmissions.

Set up new trading partner relationships, manage standards and envelopes, and perform full-cycle testing to ensure compatibility and smooth data flow.

Provide support during and post-implementation, addressing issues related to healthcare EDI applications, encounter claims, and trading partner activities.

Oversee a catalog of EDI document types and ensure detailed documentation and maintenance of process flows for all EDI activities.

Identify, troubleshoot, and resolve EDI processing errors promptly, coordinating directly with trading partners to maintain seamless data exchanges.

Recommend and implement improvements for EDI processes, document procedures, and ensure effective management and monitoring of X12 transactions.

Act as a liaison between trading partners and the department, providing timely updates and addressing issues effectively.

Maintain comprehensive records, analyze EDI transactions, and provide key activity reports to senior management.

Support internal resources by resolving EDI-related issues, facilitating user acceptance testing, and retraining staff on EDI processes as needed.

Basic Qualifications:

Strong proficiency in HIPAA X12 EDI transactions, including 837, 277CA, 834, 835, TA1, 999, 820, and NCPDP D.0.

Expertise in developing, executing, and troubleshooting EDI mapping, testing, and transmission processes.

Advanced experience setting up trading partner configurations and managing inbound/outbound transactions.

Demonstrated ability to communicate with both technical and non-technical stakeholders effectively.

Experience in Agile methodology for project development and management.

Independent worker with excellent problem-solving skills and minimal need for supervision.

Experience in creating validation rules, monitoring EDI activities, and performing detailed documentation.

Proven ability to identify issues in real-time and implement resolutions effectively.

Preferred Skills:

Familiarity with Power BI for reporting and visualization of EDI metrics.

Background in healthcare or government EDI projects is advantageous.