Lead EDI Specialist

Mode of Work: Onsite (Local Candidates Only)

Job Description: Seeking an experienced Lead EDI Specialist to support enterprise Electronic Data Interchange (EDI) operations, testing, mapping, and healthcare transaction processing within a healthcare-focused environment. The ideal candidate should possess strong expertise in HIPAA X12 EDI transactions, EDI mapping, quality assurance testing, transmission monitoring, and healthcare claims processing. This role requires hands-on experience working with EDI transaction sets, onboarding trading partners, resolving transmission issues, supporting full-cycle testing, and maintaining EDI document catalogs. The candidate should also demonstrate strong healthcare domain knowledge related to claims, provider, and eligibility processing while collaborating with internal and external stakeholders to ensure successful EDI integrations and compliance.

Key Responsibilities:

• Develop and execute test scripts related to X12 EDI transmissions
• Perform QA testing and validation of EDI applications and transaction flows
• Configure and manage EDI mappings for 837, 277CA, 834, 835, TA1, 999, 820, and NCPDP D.0 transactions
• Process, monitor, and validate inbound and outbound X12 transactions
• Support user setup, trading partner onboarding, standards configuration, and envelope management
• Conduct full-cycle EDI testing with trading partners and stakeholders
• Create and manage catalogs of EDI document types and transaction standards
• Collaborate with EDI partners to troubleshoot and resolve transmission-related issues
• Support healthcare claims processing functions including claims, provider, and eligibility transactions
• Ensure compliance with HIPAA X12 transaction standards and healthcare integration requirements
• Collaborate with technical and business teams to support EDI operations and issue resolution
• Participate in Agile-based project and delivery activities

Additional Responsibilities:

• Coordinate with internal and external EDI partners during testing and issue resolution
• Maintain EDI transaction documentation, mapping configurations, and testing artifacts
• Support continuous improvements in EDI processing, onboarding, and transmission monitoring
• Ensure accurate transaction processing and standards compliance
• Communicate technical and business issues clearly to both technical and non-technical stakeholders

Required Skills:

• Strong expertise in HIPAA X12 EDI transactions and transmission standards
• Expert-level EDI mapping experience for 837, 277CA, 834, 835, TA1, 999, 820, and NCPDP D.0
• Strong QA testing and EDI application validation experience
• Experience processing and monitoring inbound and outbound X12 transactions
• Strong understanding of healthcare claims processing including claims, provider, and eligibility systems
• Experience onboarding trading partners and performing full-cycle testing
• Working knowledge of Medicaid and/or MMIS systems
• Experience collaborating with EDI partners to resolve transmission issues
• Knowledge of Agile methodology and project delivery practices
• Excellent written, verbal, and stakeholder communication skills

Qualifications:

• Local North Carolina candidates required
• Strong business and technical knowledge of healthcare EDI environments required
• Experience supporting healthcare claims and eligibility processing preferred
• Ability to communicate effectively with technical and business audiences required