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IN-IDOH Senior EDI Developer

Spark Tek Inc

Indianapolis, IN

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JOB DETAILS
SKILLS
Adjudication, Business Analysis, Business Processes, Claims Processing, Documentation, Electronic Data Interchange (EDI), Federal Government, Health Insurance, Healthcare Providers, Help Desk, Insurance Claims, Microsoft .NET, Onboarding, Pricing, Project Management Software, Requirements Management, Software Development, Team Player, Transaction Processing/Management
LOCATION
Indianapolis, IN
POSTED
30+ days ago

Short Description:
The IndianaDepartment of Health (IDOH) is seeking an EDI expert in order to maintain and
advance its health insurance claims processing system, ACAPS.

Complete Description:
The EDI Expert is responsible for maintaining the life cycle of claims as they arrive from health providers at IDOH, are loaded into our database, are adjudicated based on state and national pricing standards, and as adjudication messages are generated and sent back to the originating provider. This position will work with the project manager, software developers, business analysts, and functional team members on the project activities.
Essential Duties / Responsibilities:
"Review update all documentation related to claims processing and EDI transactions
"Identify incompletely documented claims processing and EDI processes, and document them
"Work with development team as a SME as IDOH s ACAPS system is rewritten in .Net
"Act as liaison between OTC team and the Children s program area on claims processing issues
"Working with technical and functional staff on detailed business requirements, understanding business processes and technology, agency standards, federal and state policies to align with project s goals.
"Write technical specifications based on conceptual design and stated business requirements.
"Test new and existing systems
"Ensure accurate and appropriate file exchanges with external trading partners and resolve EDI data transmission conflicts.
"Provide helpdesk level support for EDI claim transactions.
oProvide support to healthcare providers who interact with IDOH s CSHCS system
oAssist in onboarding new providers
oAssist in onboarding new clearinghouses
"Ability to work independently with less guidance and work with ISDH externals partners as needed.

About the Company

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Spark Tek Inc

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