Core Competencies / Technical Skills:
EDI: ANSI X12 (837, 835, 834, 278, 270/271), HL7, NCPDP D.0
Integration Engines: Cleo
Platforms: FACETS, Edifecs
Databases: SQL Server, Oracle, MySQL
Tools: SQL Developer, JIRA, HP ALM, SoapUI
Methods: Agile/Scrum, Kanban, SAFe, Waterfall
Key Responsibilities:
Monitor and support daily EDI transaction flows (837, 835, 278, 834, 270/271) across multiple payer and provider integrations.
Troubleshoot and resolve production issues, including edit errors, rejected files, mapping discrepancies, and reprocessing of corrected X12 transactions.
Collaborate with trading partners to validate Authorization (278) and Claims EDI workflows.
Develop functional specifications, source-to-target mappings, data flow diagrams, and traceability documentation.
Create job aids and process documentation to support production teams and new integrations.
Participate in UAT execution, SQL validation, and post-deployment verification.
Design and support end-to-end trading partner integrations using platforms such as Cleo Cloud, EDI Fabric, and SQL-based validation.
Lead EDI production support, resolving mapping errors, reprocessing failed transactions, and coordinating partner testing.
Document workflows, ICDs, and interface specifications; collaborate with QA for regression and UAT cycles.
Conduct JAD sessions, create BRDs/FRDs, document end-to-end process flows, and perform gap analysis.
Validate backend data using SQL; support UAT and production rollout for claim pricing and member eligibility.