EDI Claims Implementation Specialist

Veriipro; Latham (NY); Sur place; USD 85 000 - 125 000; Plein temps

Résumé du poste

Veriipro in New York seeks an experienced EDI Claims Implementation Specialist to support the end-to-end rollout and ongoing maintenance of EDI claims transactions. You will work with business stakeholders, IT, and external partners to ensure accurate claims processing and system integration.

The role focuses on 837/835 transactions, mapping, testing, and troubleshooting, with a strong emphasis on data validation and compliance with HIPAA standards.

Qualifications

• Must have experience implementing and supporting EDI claims transactions.
• Strong knowledge of EDI 837/835 and X12 standards.
• Experience with EDI mapping, testing, troubleshooting, and partner integrations.
• Understanding of claims processing workflows and data validation.
• Excellent analytical, problem-solving, and communication skills.

Responsabilités

• Implement and support EDI claims transactions, including 837 (Claims) and 835 (Payment/Remittance).
• Coordinate EDI onboarding, mapping, configuration, testing, and implementation with trading partners.
• Troubleshoot EDI transaction errors, claim rejections, and integration issues.
• Validate EDI files and ensure compliance with applicable transaction standards.
• Collaborate with business, IT, and external partners to resolve implementation issues.
• Develop implementation documentation, test scenarios, and status reports.
• Support production issues and continuous improvements in claims processing workflows.

Connaissances

EDI transactions

X12 standards

EDI mapping

Claims workflows

Analytical skills

Communication

Outils

EDI platforms

Trading partners

Clearinghouses

HIPAA rules

Description du poste

We are seeking an experienced EDI Claims Implementation Specialist to support the implementation, configuration, testing, and maintenance of Electronic Data Interchange (EDI) claims transactions. The role will work closely with business stakeholders, technical teams, and external partners to ensure accurate claims processing, successful system integration, and compliance with industry standards.

Roles and Responsibilities

• Implement and support EDI claims transactions, including 837 (Claims) and 835 (Payment/Remittance Advice).
• Coordinate EDI onboarding, mapping, configuration, testing, and implementation with trading partners.
• Troubleshoot EDI transaction errors, claim rejections, and integration issues.
• Validate EDI files and ensure compliance with applicable transaction standards.
• Collaborate with business, IT, and external partners to resolve implementation issues.
• Develop implementation documentation, test scenarios, and status reports.
• Support production issues and continuous improvements in claims processing workflows.

Required Qualifications

• Experience implementing and supporting EDI claims transactions.
• Strong knowledge of EDI 837 and 835 transactions and X12 standards.
• Experience with EDI mapping, testing, troubleshooting, and trading partner integrations.
• Understanding of claims processing workflows and data validation.
• Strong analytical, problem-solving, communication, and coordination skills.

Preferred Qualifications

• Experience in healthcare claims or payer/provider environments.
• Familiarity with EDI integration platforms, clearinghouses, and HIPAA transaction requirements.
• Experience with end-to-end implementation and production support.