Healthcare EDI Developer

Summary: We are expanding our Encounter Development team and seeking a Healthcare EDI Developer to support enterprise encounter reporting through timely, accurate generation and submission of 837D X12 encounter files.

Job Responsibilities

• Execute recurring operational tasks to generate encounter data files; monitor daily production jobs, troubleshoot issues, and drive error investigation through resolution.

• Design, build, and maintain X12 EDI 837 encounter processing workflows.

• Ensure solutions comply with HIPAA and X12 standards, including state- and client-specific implementation guides.

• Perform unit, integration, and regression testing for EDI processes and related data flows.

• Interpret and reconcile 999, 277, 835, and custom state/client response files associated with encounter submissions.

• Develop and maintain data mappings between internal application data models and EDI segments/loops.

• Implement corrective actions to remediate defects and reduce or eliminate repeat issues.

• Partner with external clients and internal operational teams on new client implementations and changes to existing submissions.

• Create and execute EDI test plans and provide clear, timely status updates to internal stakeholders and clients.

Experience and Qualifications

• 3+ years of relevant experience in the healthcare industry, Dental preferred

• 3+ years of experience in a data analyst role, preferably supporting healthcare EDI.

• 1+ years of experience developing post-adjudication X12 837 files (required).

• 1+ years of SQL experience.

• Working knowledge of HIPAA X12 standards, specifically the 837 claim/encounter transaction.

• Strong attention to detail with the ability to analyze client needs and accurately document processes.

• Excellent analytical, troubleshooting, and communication skills.

• Experience with IBM Sterling B2B Integrator is preferred.