Electronic Data Interchange Developer

This role is designed to maintain and further advance existing healthcare EDI applications along with developing new EDI applications and processes. Responsible for monitoring and improving daily EDI data transfers, advancing SQL scripts to find and correct unique insurance or provider billing requirements, proactively look for claim data errors in the SQL database to correct any errors prior to the data being put into ANSI x12 file. Looking for someone who is outgoing and innovative to help take our EDI process and applications to the top of a highly competitive market.
Required Qualifications

• 3+ Years experience
• Proficient in SQL Server and SSMS
• Proficient in communications protocols including FTP, SFTP, and REST API.
• Good understanding of JSON, XML, XSLT, XSD and XML parsing processes.
• Familiar with healthcare x12 transactions (837, 835, 270/271, 276/277, etc.)
• Experience in Healthcare IT working with claims, member and provider data.

Preferred Qualifications

• Visual Basic 6.0, VBScript
• MS Access
• Knowledge of HIPAA Standards
• Experience with major clearing houses
• Strong interpersonal skills to work effectively within cross-functional teams
• Mental Health/Medical billing experience

• MySQL
• AWS

Job Duties
Daily claims submission [10%]

• Manage and monitor daily claims sending and ERA receiving procedures using in-house tools and SFTP. Troubleshoot any failed SFTP connections to claims processing centers.
• Claims cleaning/scrubbing [50%]
• Monitor claims data in SQL database to be proactive in finding any potential errors prior to claim files being generated. Work with billing specialist staff to resolve any unique billing or insurance related issues. Implement any EDI related updates from insurance companies or claims processing centers.
• Development [40%]
• Develop and maintain in-house VB Tools: EDI, claims management, and verification of benefits tools using Visual Basic 6.0
• Support legacy ASP application / VBScript
• Create and modify SQL stored procedures to alter profile and claim data to accommodate unique insurance or client requirements
• Support EDI Enrollment and changes

Work Environment
Fully in-office at San Antonio location. Remote work done via video conference.