SQA Electronic Data Interchange (EDI) Specialist

at Signature Performance, Inc. in Portland, Maine, United States

Job Description

This is a remote based position. Applicants can be located nationwide








Job Description



Position Purpose:

Responsible for verifying healthcare software's protocols, features, and functionality as well as characterizing system performance through testing, documentation, configuration and collaboration.


This position reports to the Director of PMO.

Essential Job Functions include the following. Other duties may be assigned.

Perform analysis related to solution design, development, testing, maintenance, and support for EDI interfaces and systems, both to and from trading partners and core administrative payer/payee systems

Serve as a point of contact in resolving issues related to EDI transactions related to claims, payments, enrollment, provider data, real-time transactions, clearinghouse activities, and other proprietary EDI formats

Analyze and interpret regulatory requirements and policy and operational changes from various governmental entities related to HIPAA and related EDI transactions and make recommendations and implement business and system requirements according to these specifications.

Serve as a subject matter expert in software testing and validation

Perform EDI Mapping for 837, 277CA, 834, 835, TA1, 999, 820, NCPDP D.0

Develop and execute test scripts related to X12 Transmission

Conducts QA and Testing of applications

Develop and execute Test scripts related to X12 Transmission

Develop and execute Test scripts related to TriZetto Facets

Develop and execute Test scripts related to third party business rules applications.

Track and document testing results

Assist in the setup and testing of users/new Trading Partner relationship/Standards/Envelope and full cycle testing

Provide technical support during and after implementation for healthcare electronic data interchange applications

Respond to inquiries regarding EDI issues with encounter claims and trading partner activities

Management of catalog of EDI document types such as 837, 277CA, 834, 835, TA1, 999, 820, NCPDP D.0

Maintaining detailed documentation and process flow of all EDI processes

Identify and facilitate issues with partner data mapping from onset through completion

Researching and resolving EDI errors and internal and external escalations regarding EDI related issues

Identifying errors and escalating complex issues to higher-level for assistance and review

Maintaining documents for operational procedures according to HIPAA standards and regulatory guidelines

Diagnosing problems with software and system processes and working with other technical and business resources to resolve issues related to producing documentation

Developing and maintaining documentation of software and EDI requirements and specifications

Identifies, recommends and implements process improvements in support of healthcare software systems

Troubleshoot EDI document processing errors and work with trading partners directly to resolve in a timely matter

Conducts analysis of EDI transactions and is responsible for documentation and reports

Collaborate with EDI partners to resolve transmission problems.

Track day-to-day EDI & batch processes to identify and address problems as they arise reporting levels of activity using key established metrics for senior management

Effectively communicate issues and needs with internal business partners, external vendors, and healthcare providers

Develops and maintains cross walking and validation rules for file exchanges

Triages incoming EDI issues thru monitoring

Ability to communicate effectively with technical and business staff

Support internal resources to resolve issues, answer questions, and retransmit EDI documents when necessary

Work with end users to ensure user acceptance testing is thorough and complete

Employees should be able to work independently with minimal supervision.

Knowledge of Agile Methodology

Assisting with reporting issues.

Conduct audits in partnership with the internal and external stakeholders and conduct config analysis by reviewing configuration set-up and identifying root cause of findings

Complete configuration requests as back up to coworkers and counterparts

Attend configuration staff meetings and educate/inform the Configuration Team

Identify process improvement opportunities to improve accuracy and timeliness (i.e., automation, turn around time, etc.)

Assist with Internal quality control points (peer reviews, auditing, testing, verification and validation)

Serves as SME to assist coworkers and counterparts in coaching and developing knowledge (knowledge transfer)

Participate in configuration requirement gatherings for new processes

Maintains departmental quality and production goals and objectives.

Performs other duties as assigned.

Knowledge & Experience:

Working knowledge of the... For full info follow application link.


Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled

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Job Posting: 628440

Posted On: Oct 25, 2021

Updated On: Nov 06, 2021