Note: The job is a remote job and is open to candidates in USA. EDI Staffing, an EDI Specialists Company, is seeking a Healthcare EDI SQL/SSIS Developer / Claims EDI Operations Specialist to manage the technical and administrative lifecycle of healthcare claims data. The role oversees EDI transaction processing, SQL and SSIS workflows, data validation, trading-partner support, implementation testing, reporting, automation monitoring, and claims process improvement.

Responsibilities

• Manage the end-to-end lifecycle of EDI transactions (834/835/837), including file programming, validation, output, and error resolution
• Serve as the primary liaison for trading partners, clearinghouses, payers, and vendors to troubleshoot transmission failures and rejection codes
• Manage file generation and uploads and ensure compliance with x12 formatting standards
• Research, analyze, and resolve data discrepancies between output files and source systems
• Validate file layouts and mappings, against companion guide requirements
• Ensure strict compliance with HIPAA x12 standards, CMS guidelines, and internal data policies
• Lead testing and validation for new trading partner implementations or system upgrades
• Document business requirements for implementations, system enhancements, or new trading partners
• Monitor post-go-live implementations for data accuracy and coordinate required corrections
• Develop and maintain comprehensive desktop procedures, job aids, and EOP insert revisions for new or changed processes
• Develop testing schedules and accountabilities, documenting results and lessons learned
• Perform time studies within the claims department to identify bottlenecks and document process steps
• Act as the liaison between Reporting/Data Analytics and Claims Management to drive reporting enhancements
• Maintain and distribute Claims Dashboards (Trends/Patterns) by the 5th of the month
• Develop and maintain GURU Claims Dashboard and Cards; generate reporting on usage and ROI
• Oversee Symkey Daily Robot Checks and monitor automation performance
• Train Claims Staff on Standard Policies and Procedures regarding data handling
• Maintain Desktop Procedures for Payor Audits
• Distribute operational reports to internal and external stakeholders

Skills

• 3+ years of EDI experience specifically with 834 (Enrollment), 835 (Remittance), or 837 (Claim) transactions required
• 3-5 years Medicare/Medicaid claims experience required
• Advanced proficiency in Microsoft Excel (VLOOKUP's, pivots)
• Proficiency of SQL and database querying
• Develop and maintain complex SQL queries, stored procedures, views, and data transformations using Microsoft SQL Server
• Develop, maintain, and troubleshoot SSIS packages supporting ETL, claims processing, and EDI workflows
• Trace data from source systems through SQL/SSIS processes to final EDI output and identify data discrepancies or processing issues
• Excellent data analysis skills with the ability to review data to identify trends, anomalies, and opportunities
• Excellent oral and written communication skills; capable of explaining technical issues to non-technical stakeholders
• Highly self-motivated and capable of working independently to follow issues through to conclusion
• Detail-oriented with the ability to prioritize tasks in a fast-paced environment
• Ability to maintain a high level of confidentiality and remain HIPAA compliant
• Ability to multitask in a fast-paced work environment
• Ability to remain calm under pressure and manage stressful situations
• Ability to establish highly productive and detailed organizational skills/habits
• Ability to actively listen and solve problems with cooperation, assertiveness, and flexibility for positive outcomes
• Possess strong, professional written and oral communication skills for in-person, telephonic, and electronic use
• Associate's or bachelor's degree in healthcare administration, Information Technology, or related field preferred (or equivalent technical experience)

Benefits

• Full-time, remote work arrangement

Company Overview