Edifecs Technical Lead

As an Edifecs Developer you will design build and support EDI solutions for US healthcare claims processing. You will work mainly with HIPAA X12 837 (Professional Institutional and Dental) transactions using the Edifecs platform to implement validation transformation and routing between clearinghouses web applications and internal claims systems.

Mandatory skills: -

• Hands-on experience with Edifecs Smart Trading Platform (XEngine Specbuilder Transaction Management)
• Strong understanding of US healthcare claims workflows (submission adjudication rejections/denials remittance) and terminology such as payer provider clearinghouse ICD-10 CPT/HCPCS and NPI.
• Proficiency in SQL (Oracle SQL Server or PostgreSQL) for data analysis and troubleshooting.
• Experience with XML/XSD XSLT and flat-file and delimited-file formats.
• Strong analytical debugging and problem-solving skills.

Good to have:

• Edifecs certification HIPAA/EDI certification (e.g. X12 or AHIMA/HIMSS-related) or relevant healthcare IT training.

Responsibilities: -

• Design develop and maintain EDI solutions using Edifecs (XEngine Specbuilder Transaction Management or equivalent) for inbound and outbound 837P 837I and 837D transactions.
• Build and configure HIPAA X12 validation rules including SNIP levels 1-7 and implement custom payer-specific business rules.
• Develop maps and transformations between X12 and internal formats (XML JSON flat files database structures).
• Create and maintain trading partner profiles companion guides and partner-specific configurations.
• Analyze 837 implementation guides (5010) and translate requirements into technical designs.
• Process and reconcile related transactions such as 999/TA1 acknowledgments 277CA claim acknowledgments 835 remittances and 276/277 claim status.

Required Skills:

EDIHIPAASQL837P 837I and 837D transactions