Senior EDI Developer

Crescens Inc.

Indianapolis, IN

JOB DETAILS
SKILLS
Adjudication, Business Analysis, Business Processes, Claims Processing, Communication Skills, Computer Science, Documentation, Electronic Data Interchange (EDI), Federal Government, HIPAA (Health Insurance Portability and Accountability Act), Healthcare Providers, Help Desk, High Tech Industry, IBM WebSphere Application Server, Identify Issues, Information Technology & Information Systems, Microsoft .NET, Onboarding, Presentation/Verbal Skills, Pricing, Problem Solving Skills, Project Management Software, Regulations, Requirements Management, SQL (Structured Query Language), Software Development, Team Player, Transaction Processing/Management, Writing Skills
LOCATION
Indianapolis, IN
POSTED
3 days ago
Role: Senior EDI Developer
Location: Indianapolis, IN (Hybrid)
Duration: 6+ Month
Type: Contract to Hire


Phone and in-person

Job Descriptions:
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.
  • Provide support to healthcare providers who interact with IDOH's CSHCS system
  • Assist in onboarding new providers
  • Assist in onboarding new clearinghouses
  • Ability to work independently with less guidance and work with ISDH externals partners as needed.
Required Skills:
  • Bachelor's Degree in Computer Science or related fields with IT experience
  • Database knowledge
  • Understanding EDI file formats (835, 837, 210)
  • Knowledge of HIPAA regulations
  • Ability to solve complex troubleshooting issues
  • Excellent verbal and written communication skills
  • Health Industry experience
  • Knowledge of IBM Websphere (WTX
  • Database/SQL experience

About the Company

C

Crescens Inc.

Crescens Inc. is an industry leader in providing IT staffing services and tailored workforce solutions to meet the demanding expectations and distinctive needs of clients across the United States and Canada.  We have grown tremendously in the past years and have been applauded by our clients for the quality of workforce and the quick turnaround time. We have evolved from good service to great service and all management plans are geared towards quality

Our vision is to be the best in Talent Acquisition and strive for excellence consistently by focusing on four performance dimensions; Quality, Efficiency, Cost and Risk.  A satisfied client and candidate are the backbone to our continued success. Headquartered in New Jersey, we are a team with unique expertise to deliver exceptional results to our clients by setting benchmarks and establishing best practices. 

COMPANY SIZE
20 to 49 employees
INDUSTRY
Computer/IT Services
FOUNDED
2002
WEBSITE
http://crescensinc.com/