EDI Specialist

Independent Health•Buffalo, NY

1d•$75,000 - $85,000

About The Position

The EDI Specialist will be responsible for the creation, implementation, and ongoing maintenance of Standard HIPAA 834 eligibility (inbound and outbound) formats. The EDI Specialist will have the necessary knowledge for planning, implementing and coordinating HIPAA 834 EDI projects including but not limited to end-user contact, analysis, design, mapping, training and documentation. The EDI Specialist will utilize this knowledge and be the subject matter expert responsible for providing guidance and recommendations on 834 HIPAA transactions, necessary requirements, and implementation approaches. The EDI specialist will be responsible for all converted enrollment formats to ensure quality processing of the enrollment data. This EDI Specialist will work collaboratively with business office staff and third party vendors to implement these transactions in an integrated, efficient, and cost-effective manner.

Requirements

Bachelor’s degree in Information Technology or four years of IT experience, specializing in Electronic Data Interchange (EDI) may be considered in lieu of degree.
Five (5) years of experience in EDI and/or e-Commerce required, healthcare industry preferred.
Three (3) years of experience working with ANSI X12 and HIPAA standard formats required, specifically related to eligibility.
Strong technical knowledge and familiarity with EDI and communication technologies and tools.
Demonstrated analytical and problem-solving skills.
Ability to clearly translate technical and/or complex concepts into lay terms.
Strong verbal and written communications skills with the ability to interact effectively with internal IT customers and resources, external trading partners, and upper management.
Proven examples of displaying the Nova values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.

Nice To Haves

healthcare industry preferred

Responsibilities

Implementation and development of third-party Electronic Data Interchange (EDI) solutions.
Serve as key contact for internal and external customers, trading partners and vendors providing recommendations and facilitating decisions and communications among impacted entities.
Document and analyze current business processes related to EDI and make recommendations to the manager for process improvements to create cost effective solution(s).
Develop and document EDI mapping specifications.
Work with the business to translate business requirements into functional specifications and work with our Information Technology Group and appropriate technology vendors to ensure these requirements are translated into technical requirements.
Responsible for understanding the CMS legislation to ensure that Nova is in compliance with the EDI regulations.
Analyze and report on key metrics.
Create and maintain an EDI Training Manual and internal Standard Operating Procedures.
Create and maintain an EDI Companion Guide.
Compare compatibility of EDI related products to company systems and make recommendations.
Create test plans; conduct and manage quality assurance and user acceptance testing.
Coordinate production support for on-going EDI processing.
Troubleshoot failed transmission and communicate results to internal customers and trading partners.
Facilitate meetings as needed with EDI Partners to review current EDI transactions and issues.
Research, prepare and provide training on future EDI industry changes that may affect Nova.
Provide documentation and follow-up on problem issues.
Provide documentation for software changes and new software.
Collaborate with trading partners and Independent Health to establish a Secure File Transfer Protocol (SFTP) connection.
Collaborate with the EDI Coordinator to ensure files are being received and loaded in an effective and efficient manner.