PROGRAMMER/ANALYST 4 - 08112026- 79534

The Programmer/Analyst 4 (EDI SME) serves within the Information Systems division at TennCare. This role functions as Subject Matter Expert for healthcare Electronic Data Interchange (EDI) systems, architecture, and compliance. The individual will report directly to the Programmer/Analyst Supervisor and will have no direct reports, functioning primarily as an advanced individual contributor and technical lead. This position is critical to maintaining the integrity of data exchange between the agency, managed care organizations (MCOs), and other trading partners, ensuring seamless processing of ASC X12 and NCPDP transactions., * Serve as a technical Subject Matter Expert (SME) for the architecture, analysis, and support of healthcare data transactions, specifically ASC X12 (including 837, 835, 820, and 270/271) and NCPDP post-adjudication standards (PAS 4.5 and PAS 53).

• Design, test, and troubleshoot complex mapping, translation, and routing processes for inbound and outbound EDI files.
• Draft, review, and maintain comprehensive technical documentation, including EDI companion guides, continuity plans, implementation specifications, and system architecture diagrams.
• Perform advanced root-cause analysis on translation or mapping failures, data extract anomalies, and integration issues, implementing robust solutions.
• Collaborate with vendors, trading partners, and other TennCare business units to ensure strict compliance with state and federal healthcare EDI regulations.
• Identify formatting issues within transaction elements or loops (e.g., identifying incorrect segment or element usage) and work with stakeholders to correct data submissions.
• Provide technical guidance to P/A 3 analysts, establishing best practices for data analysis, document reviews, and daily tasks.

Education and Experience: Graduation from an accredited college or university with a bachelor’s degree AND three years of professional experience in one or a combination of the following: (1) software development; (2) database design; (3) systems analysis or design; or (4) information systems instruction.

Substitution of Experience for Education: Additional professional level experience in software development, database design, systems analysis or design, or information systems instruction may substitute for the required degree on a year-for-year basis to a maximum of four years (e.g., one year of experience in the above areas is equivalent to forty-five quarter hours of coursework).

Substitution of Specific Associate’s Degree for the Required Bachelor’s Degree: Graduation from an accredited college or university with an associate’s degree in computer engineering, computer and information science, computer hardware networking, management information systems, or software development may substitute for the required bachelor’s degree., * Tech Savvy

• Manages Complexity
• Resourcefulness
• Communicates Effectively
• Self-Development

Knowledge:

• Information Technology
• Design
• Customer and Personal Service
• Programming & Computer Systems
• Mathematics

Skills:

• Active Learning and Listening
• Operations Analysis
• Judgment and Decision Making
• Technology Design
• Systems Analysis

Abilities:

• Selective Attention
• Deductive Reasoning
• Limb and/or Full Body Flexibility
• Speech Clarity
• Written Comprehension