Senior Electronic Data Interchange (EDI) Database Programmer

The position of Senior Electronic Data Interchange (EDI) Database Programmer in Analytics and Reporting Department is responsible for managing encounter data submission to CMS (Centers for Medicare and Medicaid Services) and other regulatory entities as required. The responsibility includes troubleshooting EDI mapping issues, Encounter data reporting errors, monitoring CMS Encounter Data Quality reports like MAO002, MAO003, ensuring adherence to EDI standards, writing complex SQL Queries and stored procedures, SQL Server Integration Services (SSIS) jobs for EDI file submission and troubleshooting EDI error records. Developing and maintaining EDI documentation, including process flow, cross-functional team collaboration regarding identification of EDI problem areas. Preparing test data, conditions and expected results to verify new EDI updates and logic. Build ETL for claims extract, Enrollment Extracts, Supplemental extract for DentaQuest, InComm, ModivCare etc., * Monitor and submit Encounter Data files to CMS and NYSDOH.

• Collaborate with vendors/end users on correcting EDI error transactions and resubmissions to CMS.
• Maintain ETL data extracts for EDPS Data submissions.
• Support compliance and regulatory for any inquiry on encounter data processes.
• Support CMS reporting and other regulatory reporting.
• Create KPI reports on encounter data reporting.
• Create SQL stored procedures, SSIS packages, flow diagrams and document the process for Encounter Data Reporting.
• Develop and test EDI mapping for Encounter submissions.
• Troubleshoot EDI Errors using MAO002, MAO003 reports and keep track of all the resubmissions to CMS.

Do you have experience in XML?, Do you have a Bachelor’s degree?, The successful candidate must have strong SQL programming skills, EDI Analytical skills, communication skills and healthcare experience with knowledge in membership, provider and claims data., * Bachelor’s degree in information systems, Computer Science, or Database management required. Master’s degree preferred.

• Minimum 10 years of programming experience in SQL Server database object development including but not limited to stored Procedures, functions, views, SSIS and SSRS, X12 EDI mapping and development, Troubleshooting EDI Errors.
• Minimum 5 years’ experience in complex healthcare data like Claims, Enrollment, Providers.
• Strong knowledge of EDI X12 Standards especially for transactions 837’s, 834, 277CA, 999.
• Prior experience in submitting encounters to CMS is required.
• Previous experience in BI reporting tools, such as BusinessObjects, Tableau or Power BI.
• Health Edge’s Health Rule Payor (HRP) backend table knowledge preferred
• Knowledge of Visual Studio, Net Development, XML

Professional Competencies

• Integrity and Trust
• Collaboration and Time management skills
• Functional/Technical skills
• Written/Oral Communication
• Teamwork
• Excellent analytical and problem-solving skills
• Ability to work effectively in a team environment and adapt to different projects and assignments quickly.