EDI Encounters Developer

EDI Encounters Developer

EDI Encounters Developer

Who are we?
Versant Health is one of the nation's leading administrators of managed vision care, serving millions of our clients' members nationwide. We are driven by our mission to help members enjoy the wonders of sight through healthy eyes and vision.

As a Versant Health associate, you can enjoy a comprehensive Total Rewards package, which includes health and dental insurance, tuition reimbursement, 401(k) with company match, pet insurance, no-cost-to-you vision insurance for you and your qualified dependents. We are also invested in your success. There are many opportunities for advancement and development throughout all stages of your career with us.

See how you can make a difference with the support of strong leadership and a team environment.

See Everything, Be Anything .

What are we looking for?
The EDI Encounters Developer is responsible for the development, internal production, and support process related and ensuring the timely and accurate processing of 837 X12 Encounters files for Claims submitted by Beneficiaries maintained in the healthcare claims system and other EDI related files.

Where you will have an impact
Responsible for policies and processes for importing data feeds into SQL databases and applying data analysis and understanding of backend system's member matching algorithm for loading into the claims adjudication system.
Responsible for supporting and testing HIPAA EDI 5010 X12 mapping formats (primary are 837,834,270,271,276,277,999, 835) as well as other industry standard and custom formats using ETL tools.
Develop, implement, and maintain EDIFECS, Gentran and ITXA solutions to support healthcare data exchange and integration.
Collaborate with cross-functional teams to gather requirements, design solutions, and ensure seamless integration with existing systems.
Perform data mapping, transformation, and validation using EDIFECS, Gentran and ITXA tools.
Troubleshoot and resolve issues related to EDIFECS and ITXA implementations.
Optimize performance and scalability of EDIFECS and ITXA solutions.
Provides technical support during and after implementation for healthcare electronic data interchange applications.
Responds to inquiries regarding EDI issues with enrollment, claims, payments, and/or clearinghouse activities. Conducts analysis of EDI transactions and is responsible for documentation and reports. Primary analytical role related to the claims adjudication system and internal processes.
Through the application of critical thinking processes, review, evaluate, design and implement system processes which shall result in mitigated impacts of processing and data abnormalities.
Responsible for importing, validating and reporting data into databases or exporting data from the database into appropriate EDI formats to support business processes and Plans requirements.
Implement processes that ensure the highest degree of data integrity is consistently maintained.
Coordinate with external clients and internal operations departments to ensure effectual setup and design of data formatting and flow for new client and/or product implementations. Run test files when appropriate. Own and manage the development of ongoing implementations start to finish from client meeting and companion guide review, through internal testing process and development and into production with documentation.
Design efficient solutions that ensure a high degree of data accuracy and processing efficiencies.
Manage day-to-day production file monitoring for complex EDI file processing including troubleshooting and error investigation.
The incumbent shall own the process from beginning to end. From inbound from Clearinghouses to final acceptances by plans and shall account for each Claim responses to completion.
Serve as point-of-contact for EDI related inquiries.
Ensure timely distribution of daily file processing dashboards, while maintaining the highest levels or performance metrics.
Guide and Mentor EDI Analysts within the Department.
Produce comprehensive documentation of all developed software & repositories.
Automation of routine processes with appropriate monitoring controls.
Other duties as assigned.

What's necessary to do the job?
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
Ability to write routine reports and correspondence.
Ability to speak effectively before groups of customers or Associates of the organization
Excellent presentation skills
General mathematical skills to include basic adding, subtracting, multiplication and division
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
The ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Exhibit sound and accurate judgment and demonstrate accuracy and thoroughness.
Ability to access, compile and analyze large volume data sets into concise and precise information
Ability to understand and analyze metrics
Ability to define business processes into manageable components
Excellent analytical skills
Ability to work independently as well as part of a team
Ability to multitask
Ability to prioritize essential responsibilities to ensure that business needs are met
Excellent organizational skills

HIPAA & Security Requirements
All Associates must comply with the Health Insurance Portability Accountability Act of 1996 (HIPAA) as it pertains to disclosures of protected health information (PHI) as described in the Notice of Privacy Practices and HIPAA Privacy Policies and Procedures. As a component of job roles and responsibilities, Associates may have access to covered information, cardholder data or other confidential customer information which must be protected at all times. As a result, Associates must explicitly adhere to all data security guidelines established within the Company's Privacy & Security Training Program.

Versant Health will never request money from candidates who seek employment with us and will never ask for any payment as part of the recruitment process.

Versant Health is a proud Equal Employment Opportunity and Affirmative Action employer dedicated to attracting, retaining, and developing a diverse and inclusive workforce. All qualified applicants will receive consideration for employment at Versant Health without regards to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, age, disability, national origin, marital or domestic/civil partnership status, genetic information, citizenship status, uniformed service member or veteran status, or any other characteristic protected by law.