IN-IDOH Senior EDI Developer

Short Description

The Client Department of Health (IDOH) is seeking an EDI expert to maintain and enhance its health insurance claims processing system, ACAPS.

Complete Description

The EDI Expert will be responsible for managing the lifecycle of healthcare claims as they are:

• Received from healthcare providers
• Loaded into the system/database
• Adjudicated using state and national pricing standards
• Returned to providers with adjudication messages

The role will collaborate with project managers, software developers, business analysts, and functional teams.

Essential Duties & Responsibilities

EDI & Claims Processing

• Review and update documentation related to claims processing and EDI transactions.
• Identify undocumented claims-processing and EDI workflows and document them.
• Provide expert-level support for EDI claim transactions.
• Ensure accurate file exchanges with external trading partners and resolve EDI transmission issues.

System Modernization

• Serve as the Subject Matter Expert (SME) for IDOH's ACAPS system during its rewrite in .NET.
• Work closely with development teams during modernization efforts.

Business & Technical Analysis

• Act as liaison between the OTC team and the Children's Program regarding claims-processing issues.
• Collaborate with technical and functional teams to understand business requirements, technology standards, agency policies, and federal/state regulations.
• Create technical specifications based on conceptual designs and business requirements.

Testing & Support

• Test new and existing systems.
• Provide helpdesk-level support to healthcare providers interacting with IDOH's CSHCS system.
• Assist with onboarding:
  • New healthcare providers
  • New clearinghouses

General

• Work independently with minimal supervision.
• Coordinate with external partners as needed.

Key Skills Appearing in the Description

Healthcare EDI

• EDI Transactions
• Healthcare Claims Processing
• Claim Adjudication
• Trading Partner Management
• Clearinghouse Integration

Technical

• .NET modernization projects
• System Testing
• Technical Documentation
• Requirements Analysis
• Technical Specifications

Domain Knowledge

• Healthcare insurance claims
• Healthcare provider onboarding
• State/Federal healthcare regulations
• Pricing standards and adjudication processes

Ideal Candidate Profile

A strong match would have:

• 7+ years of EDI experience
• Healthcare claims processing experience
• X12 healthcare transactions (837, 835, 270/271, 276/277, 278)
• Claims adjudication systems experience
• Experience working with healthcare providers and clearinghouses
• Business analysis and documentation skills

Required Qualifications

• Bachelor’s degree in Computer Science or a related field, or equivalent IT experience.
• 5+ years of database knowledge.
• 5+ years of experience with EDI file formats, including 835, 837, and 210 transactions.
• Knowledge of HIPAA regulations.
• Ability to solve complex troubleshooting issues.
• Excellent verbal and written communication skills.

Preferred Qualifications

• Experience in the healthcare industry.
• Knowledge of IBM WebSphere Transformation Extender (WTX).
• Database/SQL experience.

Desired Skills

• Healthcare claims processing and EDI transaction management.
• EDI troubleshooting and trading partner support.
• Requirements gathering and technical documentation.
• System testing and support.
• Experience working with providers, clearinghouses, and healthcare systems.
• Experience supporting or modernizing legacy systems to .NET platforms