Lead Edifecs resource

Key Responsibilities

• Support and monitor HIPAA EDI transactions including 837, 835, 834, 270/271, 276/277, and 278 using Edifecs tools in a Health Plan environment
• Troubleshoot EDI production issues, analyze rejected transactions, perform root cause analysis, and coordinate issue resolution with internal and external teams
• Configure, maintain, and support Edifecs applications including XEngine, SpecBuilder, Transaction Management, and Smart Trading for inbound and outbound transaction processing
• Collaborate with business users, providers, clearinghouses, and trading partners for EDI onboarding, connectivity setup, testing, and implementation activities
• Perform HIPAA compliance validation and support testing efforts including unit testing, integration testing, regression testing, and UAT for EDI enhancements and implementations
• Utilize SQL queries and healthcare data analysis techniques to investigate claims, enrollment, eligibility, and encounter processing issues
• Work closely with claims, enrollment, provider management, and infrastructure teams to support daily operations and project initiatives
• Create and maintain technical documentation including mapping documents, process flows, functional specifications, and production support procedures
• Monitor EDI transaction workflows, batch jobs, and system alerts to ensure SLA compliance and uninterrupted data processing
• Participate in release deployments, system upgrades, and ongoing maintenance activities within the Edifecs and EDI environment

Basic Qualifications: (what are the skills required to this job with minimum years of experience on each)

• Minimum 5+ years of experience working in Healthcare EDI and HIPAA transaction processing within a Health Plan or Healthcare environment
• Minimum 3+ years of hands-on experience with Edifecs tools such as XEngine, SpecBuilder, Transaction Management, and Smart Trading
• Minimum 3+ years of experience supporting HIPAA X12 transactions including 837, 835, 834, 270/271, and 276/277
• Minimum 2+ years of experience troubleshooting EDI production support issues and performing root cause analysis
• Minimum 2+ years of experience working with SQL for healthcare data analysis, validation, and issue investigation
• Experience with trading partner onboarding, EDI connectivity protocols such as SFTP/AS2, and compliance testing activities
• Strong understanding of healthcare claims processing, enrollment, eligibility, and encounter management workflows
• Experience working with incident management and ticketing tools such as Jira or ServiceNow

Travel:: This position may require occasional travel based on project and business needs.

Degree:

Bachelor’s degree in Computer Science, Information Systems, Healthcare Informatics, or equivalent work experience

Nice to Have; (But not a must)

• Experience supporting Medicare, Medicaid, or Commercial Health Plan operations
• Project lead or offshore/onshore coordination experience
• Knowledge of XML, XSD, and EDI mapping concepts
• Experience working in Agile development and support environments