Specifically, we are looking for someone with PBM domain knowledge and experience implementing EDI feeds in the context of Eligibility, Accumulator and Max out of Pocket processes.
• Conduct analyses of business needs, work with the Business Analyst to document requirements from existing code base and logic, as necessary. Review programming requests and work with project manager to identify, gather, analyze, and develop code base to support each EDI assigned.
• Develop requirements tractability matrix to be used in software development and QA testing.
• Work with project leadership and business analyst to document current work flow processes and collaborate with users in identifying, defining, and documenting process improvement options and alternatives to support business needs.
• Work with business analysts to elicit and document business rules from the legacy code base. Identify required data fields based on State mandated requirements/requests.
• Participate in systems development efforts. Participate in testing, acceptance testing and implementation of information systems, modules and subsystems.
1. Ideal candidate will have extensive experience configuring Edifecs (and creating maps) for translating and validating HIPAA 5010 transactions and customized transaction formats, can lead a team in a new configuration along with excellent written and verbal communication skills.
2. Key skills to include: - Edifecs configuration - XEngine Service (XES), and XEngine Server - MapBuilder - Configuration, set-up, and installation using Edifecs. - Creating detailed requirements from a Developer perspective, low level design at the component level for different healthcare HIPAA transactions.
3. XML / XSLT code writing and XML parsing. Code deployments, and automatic builds. 4. Desired Skill or Knowledge of: - Edifecs Routing (EAM) Resources need to have a full understanding of EDI, how to help users determine their mapping specifications/requirements, code in java script and groovy to handle the customization that might be needed, create Edifecs routes, agreements, and configure relationships. All this is part of setting up a new account in Edifecs so that data is translated and validated per requirements/specifications and is processed (flows) to all the appropriate applications.