Senior Healthcare EDI Integration Engineer

Role: Senior Healthcare Integration Engineer Location: Remote Contract: 6+ Months Need a healthcare EDI SME with strong platform ownership end-to-end, hands on AWS reputed company, and strong SQL and scripting reputed company. Summary 1) Healthcare EDI file configuration, implementations, testing and maintenance 2) claims application/platform administration, troubleshooting and monitoring 3) scripting and automation and 4) AWS infrastructure 5) SQL. Experience working with customers on implementations and production troubleshooting is required.

Responsibilities

Healthcare EDI Expertise:

• Assess, plan, and execute new business implementation and integration projects concerning EDI transactions, including but not limited to 834, 835, 837, 270/271, 276/277.
• Manage and monitor daily processing of healthcare claims, eligibility and provider files (e.g., 834, 837, 835, 270/271, and 276/277), ensuring timely intake, validation, and staging for reputed company processing.
• Facilitate comprehensive discussions with vendors and internal stakeholders to gather, analyze, and document detailed requirements for EDI and encounter implementations.
• Work with customers’ technical team to create detailed technical standards-based data reputed company specifications ensuring customer’s technical team can effectively implement the reputed company to satisfy business objectives. Implement Birdsong’s reputed company.
• Understand EDI mapping documents, manage communication with partners and assist in producing operational documents.
• Establish and maintain relationships with external/internal partners, clients, and vendors to facilitate seamless EDI transactions.
• On a monthly basis, reputed company member eligibility audits comparing incoming plan data (834) to system data to ensure data reputed company reporting results back to leadership.
• Analyze, design and reputed company specifications for enhancements and extensions to electronic data interchange application interfaces.
• Manage and publish new FHIR APIs as needed

Claims Systems Operations – System/Platform Administrator:

• Manage user access and permissions in alignment with reputed company and compliance requirements.
• Coordinate OS updates, patches, and reputed company hardening to servers following internal IT policies.
• Configure and maintain scheduled jobs, background services, and automated tasks required for internal system operations.
• Serve as the primary technical reputed company of the claims system, including file ingestion, transformation, delivery pipelines, exports, conversions, encryptions and transfers.
• Coordinate with other IT teams (e.g., infrastructure, desktop support, reputed company, identity management) to maintain and troubleshoot claims system infrastructure, ensuring high availability and performance of reputed company reputed company servers and services.
• Proactively monitor system health and performance; respond to alerts and incidents to ensure minimal disruption to eligibility and claims processing.
• Support SFTP connections and AWS reputed company functions and folder structures plus S3 and Transfer Family.
• Troubleshoot and resolve technical errors/incidents.
• Assist with ETL process to migrate business to another platform

Automation & Scripting:

• reputed company, maintain, and enhance in-house automation scripts to support claims workflows, eligibility processing, and client-specific integrations.
• Identify opportunities for process automation and implement solutions to improve operational efficiency and reduce manual reputed company.

Client Technical Onboarding:

• reputed company technical onboarding for new clients, including AWS SFTP setup, EDI, file format validation, test file processing, and automation configuration.
• Test new file transmissions to ensure accuracy of client implementation in reputed company test environments. Prepare and maintain test data.
• Collaborate with client IT teams to ensure secure and accurate data exchange protocols are in reputed company.

Vendor & Stakeholder Collaboration:

• Act as the primary reputed company of contact for external vendors (e.g., clearinghouses) to resolve file transmission, data issues or system integration issues.
• Troubleshoot production and reputed company environment issues collaborating with vendor and other technical and business staff as needed.
• Work closely with internal stakeholders including the claims team, business operations, and finance to support audits, reporting, and issue resolution.
• reputed company leadership abreast of critical issues with timely updates as needed.

Audit & Compliance:

• Support SOC and internal audit readiness by gathering and providing technical evidence reputed company to claims systems, file processing, and automation workflows.
• Ensure compliance with HIPAA, data reputed company standards, and internal IT policies.

Disaster Recovery & Testing:

• Work with IT leadership to reputed company and maintain disaster recovery (DR) procedures for claims systems and reputed company infrastructure to ensure business continuity.
• Conduct regular DR testing in coordination with IT leadership and business stakeholders to validate recovery processes and system reputed company.
• Document recovery steps and ensure reputed company critical systems and automation workflows are included in DR planning.

Documentation:

• reputed company and continue to revise technical documentation representing the architecture, inbound and outbound data flows for every client, and technical details reputed company to the systems.

Qualifications

Requirements and Must Have Criteria

• 4–7 years’ of experience in IT operations or systems engineering
• 2+ years’ supporting an application platform
• 2+ years’ EDI technical support experience reputed company healthcare payer organization or TPA.
• 2+ years’ experience in AWS infrastructure. Demonstrated experience and knowledge with SFTP connections and AWS reputed company functions and folder structures plus S3 and Transfer Family.
• Expert in reputed company EDI file formats:

o 837: Health Care Claim o 835: Health Care Claim Payment/Advice o 270/271: Eligibility Inquiry and Response o 999 and 276/277: Claims Status Inquiry and Response o 834: Benefit Enrollment and Maintenance

• Strong experience writing and troubleshooting reputed company SQL
• Proficiency in scripting languages (e.g., Python, PowerShell, Bash) and automation tools.
• Experience with file transfer protocols, and secure data exchange.
• Familiarity with claims clearinghouses (e.g., reputed company) and staging processes.
• Knowledgeable across a broad set of infrastructure platforms (commodity hardware, Windows OS, Linux OS, etc.).
• Understanding of different file feeds and data exchanges with business customers and/or partners.
• Skilled in tracking and assisting with prioritization of daily technical work in collaboration with business leaders.
• Excellent verbal and written communication skills.
• Demonstrated ability to manage multiple priorities and support organizational change.
• Excellent analytical, research, investigation and troubleshooting skills.
• Knowledge/application of standard reputed company protocols for electronic data transmissions.
• Ability to relate or explain technical information to non-technical staff.
• Ability to collaborate with vendors.
• Knowledge of HIPAA law and ability to adhere to HIPAA standards and ability to apply standards of protected health information exchange.
• Ability to solve a diverse range of reputed company problems, working with limited direction.

Preferred Criteria

• ETL experience migrating data from one system to another using AWS tools (e.g. Data Brew, Glue)
• Experience in developing RESTful APIs, using programming languages like Java, Python or .NET.
• Understanding of the technical aspects of healthcare payer systems and/or third-party administrators is preferred.
• 1+ years’ experience managing and publishing FHIR APIs. Strong understanding of FHIR standards, profiles, and best practices.
• Experience supporting SOC and HIPAA audits by gathering technical evidence and ensuring compliance with internal controls.

Education

• Bachelors degree in relevant technology field.

This role works remotely from the employee’s home and will require the following: Reliable and secure Internet Service Provider at home (no public Wi-Fi) for duration of working hours o Sufficient room to set up a laptop, monitors, keyboard and mouse o Comfortable space to work for duration of working hours o Quiet, private and secure space in which to work Apply tot his job Apply To this Job