EDI Technical Architect
Role details
Job location
Tech stack
Job description
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Lead configuration efforts for cross functional teams on multiple state implementations.
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Manage and coordinate code development and contract deliverables for one or more claims processing functional areas.
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Facilitate client, offshore and/or internal requirement and training sessions, including but not limited to;
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Hosting calls with the development team to discuss design review issues, development status and testing.
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Identify and/or review requirement changes if issues determined during development or testing. Determined and documented design changes needed to support requirement changes and reviewed with internal staff prior to submission and review with the client.
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Reviewed conversion data loads reporting any issues or clarifications needed.
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Hosted calls with the State staff to review and resolve design, testing and/or vendor issues.
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Conduct "Train the trainer" sessions to train operations and State Staff members on functionalities of the MMIS system via the MMIS Web Portal.
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Validate and/or create Lesson Modules. Developed training schedule an setup meetings. Create training agendas and practice exercise documents. Performed test data setup as required.
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Provide onsite support for system implementation by reviewing processing alongside the State users, addressing issues encountered and determining resolutions as needed.
- Post implementation responsibilities include day-to-day functional area operations and the design, development, and implementation of processing issues and any requested changes.
- Review daily and periodic reports and system alerts, host client meetings (weekly, monthly and adhoc) to discuss functional area processing issues with the State resources and applicable State vendors as well as discussions on development priorities, defect resolutions (both internal (HE) and external (State vendors or Source system staff) and upcoming client changes. 2.Reviewed and prioritized resolution of issues reported both internally and by the client.
- Managed the development of functional change requests (CRs) by gathering the requirements and designing the changes to the existing product design to meet and support new processing requirements.
- Analyze the requirements and determine the scope of the processing and system configurations within pone or more functional areas that would be impacted to support the new requirements.
- Create an Impact Analysis document detailing the design changes needed to support the State's requirements. This task required reviewing the existing configurations (system lists, parameters, etc.), processing specifications for each functional process impacted, reports, database changes and/or any new functionality that needs to be added. If updates are required across functional areas, I had to coordinate and consolidate the IA details for review with the State. Once the details of the requirements are reviewed and approved by the State the IA is submitted to the development and QA teams for their assessment (hours). The resulting Impact Analysis document would detail the system modifications needed along with the hours assessed for tasks performed by the SME, Development and QA teams. This document is submitted to the PMO for finalization and submission to the State.
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Create design changes by updating/adding rules, configuration requirements, new table specifications (if required), updates to specification documents (use case, interface, UI, exhibits, etc.). If changes were required across multiple functional areas coordinated with the respective SME to incorporate their respective area updates in the deliverables to the State.
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Schedule meetings with the State to walk through the details of the design changes for each area.
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Responsible for reviewing and resolving any design issues cited by the development team. Review unit test results and the test scenarios drafted by the QA team sending my approval and/or comments to each team. Review SIT test results as completed by the QA team, sending my approval for the developed code to be delivered for User Acceptance Testing or returned for any testing issues or code corrections determined.
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Where applicable developed implementation workplan detailing tasks required to implement large scale system changes. Most of these manual tasks required to allow processing to begin once the code was deployed. Candidate must have skills:
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Re-engineer - Architect and design EDI transactions (270, 271, 276, 277, 278, 820, 834, 835, 837, 999, etc.
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Expert in designing and implementing end-to-end data warehouse architectures using modern ETL and Datawarehouse technologies, healthcare interoperability standards (X12, EDI, HL7, FHIR), and advanced analytics platforms to support data-driven decision making across healthcare systems.
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Work closely with the MMIS Team and Operations Team on various systems including Provider and Claims and the associated nightly/daily batch processes ensuring 24/7 operations.
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To be successful, the Technical Business Systems analyst must be a seasoned, experienced professional with a full understanding of systems analysis, production support, batch cycle processing, quality assurance, report development, query development, requirements gathering and documentation creation.
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Familiar with MMIS batch cycle processes, IBM Workload Automation, and ability to provide on-call Support (including evenings, weekends, and holidays.
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Experience with Optical Character Recognition (OCR) - Familiarity with healthcare claim OCR processes including daily balancing.
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Familiar with X12 mapping across multiple transaction types.
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Provide technical problem solving and deep solution expertise to the customer, QA and Development teams. Provide technical leadership, guidance, and help to drive the strategies proposed by the client and the Conduent team.
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Leverage hands-on customer experience and proof-points to educate and engage the broader community of prospects, customers, partners and coworkers.
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Support reporting needs of internal and external business users.
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Analyze business processes and performs needs assessments in an effort to align various information technology solutions with business initiatives.
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Interpret business needs and translates them into the different system requirements.
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Write business specifications and forwards to technical staff for development of the various systems.
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Interpret different systems specifications to develop, maintain and support automated business processes where applicable.
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Provide technical expertise in identifying, evaluating and developing systems and procedures that are cost effective and meet user requirements.
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Configure system settings and options, plans and executes acceptance testing, and creates specifications for systems to meet business requirements.
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Demonstrate good judgment in selecting methods and techniques for obtaining solutions.
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Network with senior internal and external personnel in own area of expertise.
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Operate with little instruction on day-to-day work and general instructions for assignments.
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Demonstrate analytical aptitude with attention to detail and proficiency with SQL Developer.
Requirements
- Bachelor's Degree or equivalent working experience.
- 5+ years of experience in developing and implementing Healthcare EDI Transactions.
- Must have experience in EDI Transformation projects.
- Must have working experience in architecting and designing EDI transactions (270, 271, 276, 277, 278, 820, 834, 835, 837, 999, etc.
- Requires a minimum of 7 years of production support.
- Requires a minimum of 10 years of related experience any of the following:
- Healthcare functional area expertise - preferred in Claim Adjudication, Claim Payment, Member Enrollment & Eligibility.
- Systems Analysis
- Quality Assurance
- Report Development
- Query Development
- Requirements Gathering
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Minimum 7 years of experience and understanding of large scale infrastructure deployments in enterprise-wide environments required.
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Minimum 5 years of experience in applications such as Azure, ReqPro, DOORS and ETL. Preferred Qualifications For Consideration: This is nice to have or wish list. Experience on implementing or maintaining one or more claim processing functional areas in either a development/configuration setting or maintenance setting - desire work and details on minimally 3-5 initiatives. Must be able to provide adequate information on company, account and product ensure validation and limited background check.
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Intermediate to skilled proficiency in writing SQL queries.
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Ability to communicate effectively, successfully interact with internal and external stakeholders, work both independently and as part of a team, and work efficiently to handle competing priorities.
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Agile process experience
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Microsoft Tools Suite
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Provider MMIS Systems
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Claims MMIS Systems functional area expertise
Benefits & conditions
We are currently interviewing to fill this and other similar positions. If this role is not a fit for you, we do offer a referral bonus program for referrals that we successfully place with our clients, subject to program guidelines. ASK ME HOW. Thank you! Kiran Vajrala Manager PAY RANGE AND BENEFITS: Pay Range*: $ 96,500 - $ 113,500 Per Year
