Job Description :
Must have recent experience with HIPAA EDI/ Healthcare transactions including: 834, 835, 837, 820, 999, and 270/271
Experience with ANSI X12 Standards, particularly X12 Companion Guides and transactions sets involving Eligibility, COB, Provider, Claims, Benefits / Payment
Hands-on expertise writing SQL scripts , creating EDI test files, query building & reporting using MS SQL Server
Responsible for writing complex system requirements, test scenarios, along with technical requirements/database mappings after reviewing the business requirements documents
Act as a liaison between Business Analysts and IT technical team
Supports the development of technical specifications and provides ongoing assistance and consultation to software developers to resolve problems to ensure that the application software meets the client’s requirements
Manages, tracks, and communicates status of technical requirements documentation.
Manages changes to baseline technical requirements documentation.
Troubleshoot application issues with developers and end users to ensure technical compatibility and end user satisfaction
Prepare detailed flow charts, reports and diagrams that constitute a representation of all systems in terms which Managers or non-data processing personnel can understand
Ensures issues are identified, tracked, reported on and resolved in a timely manner.
Strong analytic and problem-solving skills
Ability to work independently and as a member of a team
SPECIAL KNOWLEDGE AND/OR SKILLS
Familiarity with key Medicaid managed care functions including claims, enrollment, and Medical Management.
A minimum of 4 years current experience working with QNXT.
Knowledge of Medicaid coverage types, coverage span, and eligibility rules.
In-depth understanding of 834 enrollment transactions including Adds, Terminations, Audit, Changes and Life events.
Experience with software testing and/or defect tracking and testing tools.
Strong interpersonal and communication skills.
WORK BACKGROUND/EXPERIENCE
Experience with the health insurance industry.
A minimum of 4 years working in Information Systems
Experience with the development, implementation, and maintenance of large-scale systems, preferably across multiple hardware and software platforms.
A minimum of 4 years of experience with Healthcare EDI solutions.
A minimum of 4 years of experience in creating EDI X12 files for transactions sets such as 834, 837, 835, 999 and TA1.
Previous Technical Analyst experience.