Key Responsibilities- Design, develop, configure, and maintain Edifecs applications and healthcare EDI interfaces.
- Develop and support HIPAA transaction processing including 834, 835, 837, 270/271, 276/277, and 278 transactions.
- Configure and maintain Edifecs modules such as XEngine, SpecBuilder, Transaction Management, and Smart Trading Partner Management (STPM).
- Analyze business requirements and translate them into technical solutions.
- Create mapping specifications and validation rules for inbound and outbound healthcare transactions.
- Troubleshoot production issues, perform root cause analysis, and resolve data integration problems.
- Collaborate with business analysts, product owners, vendors, and operations teams to improve EDI workflows.
- Support testing activities including unit, integration, regression, and user acceptance testing.
- Ensure compliance with HIPAA regulations and healthcare industry standards.
- Develop technical documentation, design documents, and support procedures.
Required Qualifications- Bachelor's degree in Computer Science, Information Systems, Healthcare Informatics, or related field.
- 3+ years of Edifecs development experience in a healthcare payer environment.
- Strong experience with Edifecs XEngine, SpecBuilder, Translator, and STPM.
- Knowledge of HIPAA EDI transactions (834, 835, 837, 270/271, 276/277, 278).
- Experience with XML, X12 EDI, SQL, Java, and Web Services.
- Familiarity with healthcare claims, enrollment, provider, and eligibility processes.
- Experience troubleshooting production support issues and implementing fixes.
- Strong analytical, problem-solving, and communication skills.
Preferred Qualifications- Experience working with Medicare, Medicaid, and Commercial Health Plans.
- Knowledge of FHIR APIs and modern healthcare interoperability standards.
- Experience with cloud platforms such as Azure or AWS.
- Healthcare payer or managed care industry experience.
- Edifecs certification preferred.
Technical Skills- Edifecs XEngine
- SpecBuilder
- STPM
- Transaction Management
- X12 EDI
- HIPAA Transactions
- XML/XSLT
- SQL
- Java
- REST/SOAP APIs
- Healthcare Claims Processing
- Eligibility & Enrollment Systems
Salary RangePerks and benefitsTop talent deserves top rewards. We've carefully curated a best-in-class benefits package, meant to meet you wherever you are in your life and career.
- Your health, holistically. We offer a choice of multiple health and dental plans with nationally recognized networks, as well as vision benefits, a total wellness program, and an employee assistance program for you and your family.
- Your financial well-being. We offer competitive wages, retirement savings plans, company-paid disability and life insurance, pre-tax savings opportunities (HSA and/or FSA), and more.
- And everything in between. Our lifestyle benefits are unrivaled, including professional development offerings, opportunities for remote work, and our favorite: a generous paid-time-off program, giving you the flexibility to plan a vacation, take time away for illness (or life's important events), and shift your schedule to accommodate those unexpected curve balls thrown your way.
