EDI Developer

We are seeking a Senior EDI Developer to maintain, support, and advance a critical healthcare insurance claims processing system. In this role, you will manage the end-to-end lifecycle of healthcare claims-from provider ingestion and database loading to pricing adjudication and outbound messaging response generation.

You will collaborate closely with project managers, software developers, and business analysts while acting as a critical Subject Matter Expert (SME) during a major system modernization., * System Modernization: Serve as the EDI Subject Matter Expert (SME) to guide the development team as the core legacy claims system is rewritten in .NET.

• Data Exchange & Integration: Ensure accurate, secure file exchanges with external trading partners and rapidly resolve data transmission conflicts.
• Support & Onboarding: Provide helpdesk-level troubleshooting for EDI transactions, assist with onboarding new healthcare providers, and manage clearinghouse integrations.
• Documentation: Review, update, and author technical specifications and business requirements for completely undocumented claims processes.

• EDI File Formats: 5+ years of hands-on experience handling 837 (Claims), 835 (Remittance Advice), and 210 (Invoice) transactions.
• Database Knowledge: 5+ years of solid SQL and database experience for mapping and validating claims data.
• Compliance: Robust understanding of HIPAA regulations and data privacy standards.
• Education: Bachelor’s Degree in Computer Science, IT, or a related technical field.

Highly Desired (Strong Pluses):

• Healthcare Industry Experience: Deep understanding of medical billing, insurance claims workflows, and adjudication standards.
• IBM WebSphere Transformation Extender (WTX): Practical mapping or development experience with WTX.