Onsite/Local Cloverleaf EDI Architect/PM

Onsite/Local Cloverleaf EDI Architect/PM (Cloverleaf Level II/Mirth/15+) with X12, HL7, Mirth, Unix, Java, Python, SQL server, ETL/ELT, HIPAA compliance experience, 3.1. SERVICE TASKS: Contractor will perform the following tasks in the time and manner specified: 3.1.1. As directed by the Department, design an integration engine that will perform: 3.1.1.1. X12 message parsing and transformation; 3.1.1.2. Rule-based business logic for intelligent routing; and 3.1.1.3. Multi-endpoint routing capabilities using identifiers other than FEIN 3.1.2. As directed by the Department, configure and implement an integration engine that will: 3.1.2.1. Intercept outbound 837 claim transactions from ESDS and evaluate routing rules at the loop and segment level; 3.1.2.2. Direct each transaction to the appropriate clearinghouse endpoint based on billing NPI, submitting provider, or other applicable X12 attributes; and 3.1.2.3. Evaluate and route incoming 835 remittance files and acknowledgment transactions (999, 277, 271) back to the correct LES office or payer source. 3.1.3. As directed by the Department, complete the following service tasks following project management industry best practices: 3.1.3.1. Gather functional and technical requirements related to billing, remittance workflows, X12 routing rules, and integration behavior; Contractor will document requirements and confirm alignment with ESDS business processes. 3.1.3.2. Provide weekly status updates summarizing work completed, upcoming tasks, risks, issues, and any schedule or resource concerns. 3.1.3.3. Maintain a work plan outlining tasks, milestones, estimated completion dates, and any changes requiring Department communication. 3.1.3.4. Support user acceptance testing (UAT); Tasks include coordinating test execution, preparing test data, tracking defects, and verifying corrections. 3.1.3.5. Provide basic training and knowledge transfer related to the integration engine s functionality, routing logic, dashboard/monitoring tools, and new or updated workflows. 3.1.3.6. Provide documentation of integration configurations, routing rules, data flows, and any updates or changes performed during the project. 3.1.3.7. Assist the Department with planning, coordinating, and executing deployment activities, including cutover, validation of data exchanges, monitoring of initial transactions, and post deployment issue resolution. 3.1.3.8. Provide weekly status updates. 3.1.3.9. Provide at least one full-time resource.

Contractor staff assigned to this agreement must possess the following minimum qualifications and experience: 2.1. A minimum of ten years of experience performing data integration services for customers that required 24/7 data interchange, that exchanged data with more than 20 partners, traded over 100,000 records/messages per month, and included translation of health-related information including extensive use of standard formats such as Electronic Data Interchange (EDI) X.12 and Health Level 7 (HL7). 2.2. A minimum of five years of experience designing, building, and supporting data exchanges that use Cloverleaf and Mirth data exchange engines. 2.3. A minimum of five years of experience designing, building, and supporting data exchanges that use file encryption methodologies. 2.4. A minimum of five years of experience developing and maintaining Unix, Java, and Python based data integration related scripts. 2.5. A minimum of ten years of experience in data integration initiatives using SQL server queries, databases, streaming and batch ETL/ELT (Extract, Transform, Load and Extract, Load, Transform) processes, enforcing data governance principles. 2.6. A minimum of ten years of experience designing scalable and efficient data exchange architectures tailored to the specific needs and objectives of a government organization and applying best practices in data exchange architecture and management. 2.7. A minimum of seven years of experience working with healthcare data and regulatory requirements, including HIPAA (Health Insurance Portability and Accountability Act) compliance, robust data security and access standards. 2.8. A minimum of seven years of experience in project management practice managing the implementation of assigned projects tasks, including timelines, and communicating effectively with stakeholders. 2.9. A minimum of two years of experience working with the latest standards for healthcare data exchange, integration tools, and data transport methods. Training or certifications on these within the last two years can substitute for the required experience. 2.10. Consultants assigned to this project must have a minimum of a bachelor s or master s degree in computer science, data science, information technology, or five years minimum of experience in the field. Relevant certifications in data integration tools, (e.g., Cloverleaf Level II and Mirth) is preferred.