EDI Technical Specialist - 6 Months Contract (US Remote)

Company Description

The U.S. health sector is complex and dynamic - a vast and diverse network of entities that impacts the population and economy like no other industry. At USD$4.1 Trillion, healthcare spending represents nearly 18% of U.S. GDP. It is complex and inefficient. Health service buying, selling, and settlements have seen little change in the past decade despite clear changes in available information, technology, regulation, and market consolidation.

Enter MacroHealth. MacroHealth is a mission-driven company. We are building the most advanced and trusted market platform for health service payers and providers. The company’s vision is to create Intelligent Health Markets by building technology, knowledge and relationships that enable payers and providers to optimize the buying and selling of health services.

We are expanding our team of passionate thought leaders as we pursue our goal of disrupting the U.S. health sector with our vision and technology. We are committed to developing leading edge solutions in a supportive environment focused on customer success and employee fulfillment. 

Job Description

MacroHealth has exciting opportunities for multiple customer facing EDI Technical Specialists with a design and implementation focus. The ideal candidates will have experience with EDI and Data Exchange analysis and workflow design. You must have experience working with or directly for a Health Plan Commercial Payer. 

 
In addition, you are a self-starter with the ability to take ownership, work with tight timelines, and handle various tasks simultaneously while continuing to develop a positive work culture. 

This is a 6 months full-time contract. Start date: February 2023.
 
Responsibilities: 

• As a SME, provide EDI and industry knowledge-sharing across all of the company teams 
• Work closely with Healthcare Payers and Networks to understand their operational and technical integration requirements to create data exchange specifications and requirements to support health plan data integrations 
• Work with customer (payers), networks and partners to define requirements and design integration solutions 
• Produce documentation to achieve high quality integrations 
• Maintain a deep understanding of the company's platform product capabilities 
• Assist with internal testing and work closely with customers during UAT phase of implementation projects 
• Build and continuously optimize implementation processes and procedures 
• Work closely with Product Management to provide input and feedback on platform features and functionality to support building customer integrations. 
• Proactively work to identify new features required to optimize integrations 
• Participate actively in Scrum related activities, including sprint planning and grooming. 
• Work closely with engineers to provide clear requirements for building customer integrations 
• Build and test customer integrations and documentation 

Qualifications

• 5+ years' experience as a software Systems Analyst or Business Analyst, gathering/documenting business requirements and translating into technical specifications. 
• 3+ years' experience working in a US Health Plan Commercial Payer environment. 
• Expert understanding of HIPAA transaction sets like 837,834. 
• Hands-on experience with HIPAA logical mapping and system implementation. 
• 3+ years' experience in an external, client facing role 
• Experienced in Claims Processing, Benefit Enrollment, Medical/Pharmacy encounter processing, Trading Partner enrollment, Provider enrollment, and resolving provider's claims-related issues 
• Experience analyzing, designing, and maintaining Business process Workflows. 
• Experience with Troubleshooting and resolving EDI and other Data issues in a production environment 
• 835 implementations including non-compliance remediation; diagnosis, root cause identification, remediation recommendation, implementation, and testing. 
• General knowledge of healthcare operations, payer business processes and provider and EDI infrastructures. 
• Experience with building cloud services or SaaS technologies. Strong knowledge of and aptitude for cloud computing principles. 
• Ability to develop strong working relationship with engineering and stakeholder groups, and the curiosity and skill to dig deeper into requirements and the "why " with limited guidance. 
• BS in Computer Science/Information Systems or equivalent experience. 
• Excellent oral, written documentation, and presentation abilities. 

Your Background May Additionally Include: 

• MS in Computer Science/Information Systems 
• Claims, enrollment, and pricing configuration experience 
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