Edi Order Processing Jobs in Massachusetts (NOW HIRING)

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world's leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.
Our work centers on creating an exceptional member experience - a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills.
We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more.
MGB Health Plan is seeking an experienced EDI Developer responsible for the design, development, implementation, and ongoing maintenance of healthcare EDI solutions supporting HIPAA transactions, including but not limited to 270/271, 276/277, 278, 820, 834, 835, 837, and 999. The idea candidate has a strong understanding of HIPAA EDI implementation and companion guides used across the healthcare industry to ensure compliant and reliable data exchange.
The EDI Developer must have handson software development experience and demonstrate the ability to follow established design principles, coding standards, and best practices. The role works closely within crossfunctional project teams, adhering to SDLC processes throughout the lifecycle of development, testing, deployment, and support.
Strong technical proficiency is required, including C#/.NET development, SQL and related tools such as SQL Server Management Studio (SSMS), SSIS, TSQL, and experience working with Microsoft SQL Server. Experience using Visual Studio and BizTalk Server in support of EDI and integration workflows is essential.
Experience within healthcare payer environments is highly valued. Preferred qualifications include exposure to QNXT (claims and enrollment processing systems), ASP.NET development, and XML/XSLT programming, which support complex EDI transformations and integrations.
Primary Responsibilities:
-Programming, including writing T-SQL in SQL Server and SSIS packages, which support the Vendor Interfaces.
-Analyze business and system requirements, including impact analyses on existing systems, to develop systems specifications
-In partnership with the business units, design, prepare and execute unit test plans for application upgrades and enhancements.
-General data mapping of ANSI HIPAA EDI files, including coding, translation, development, testing and deployment or EDI applications.
-Perform analysis on systems and processes to become a subject matter expert, in order to help and support the business units.
-Work with hosted vendors to accomplish SDLC objectives
-Provide data analysis support for NHP business areas in order to assist with the business areas' information, reporting and application development needs. -Data analysis entails understanding the flow of data and its interdependency among QNXT core modules such as Member
-Enrollment and Services, Claims Processing, Provider Relations, Clinical Systems and Finance.
-Track and monitor problem tickets to insure timely resolution
-Communicate status and escalate issues as needed.
-Identify and resolve problems related to business processes and applications.
-Coordinate and/or perform change and revision management to ensure inter-operability of systems
-Anticipates and meets, or exceeds, internal and/or external customer expectations and requirements; establishes and maintains effective relationships with customers and gains their trust and respect.
-Assist in requirements gathering with end users to clearly define information needs and translate those requirements into specifications for development.
-Participate in change management, disaster recovery and production support operations.
-Coordinate technical support and software upgrades with in-house staff and outside vendors to ensure NHP applications are performing effectively.

Education

• Bachelor's Degree preferred; experience can be considered in lieu of a degree

Experience

• At least 5-7 years of experience in application development and design required
• At least 3-5 years of experience in application development, support and maintenance in a dynamic, Microsoft environment. Healthcare systems related experience preferred
• Experience with QNXT and CCA or other Integrated HealthCare Systems - ASP.NET, C# and SharePoint Applications preferred
• Experience required in SSIS packages, ANSI X12, XML, HL7 formatted EDI transactions preferred

Knowledge, Skills, and Abilities

• Understanding of the data dependencies that exist between applications and systems
• Experience with the development and support of intra-application data exchanges, job scheduling, and inter-job dependencies
• Demonstrated ability to develop customized solutions to meet business requirements
• Must have demonstrated ability to interact effectively and maintain productive interpersonal relations.
• Accountable for delivering high-quality work
• Respects the talent and unique contribution of every individual
• Understanding of core programming principles, including design.
• Ability to work in at least one programming language (ex: JavaScript, SQL, etc.).
• Strong analytical, programming, and demonstrated project management skills.
• Excellent communication skills, both written and oral.

Working Conditions

• While this position is designated as remote, all employees, including those classified as remote, may be required to attend meetings, trainings, or other necessary functions onsite at a Mass General Brigham location on an as-needed basis. Reasonable notice will be provided for any required in-person attendance.
• M-F Eastern Business Hours required
• Flexibility for business needs to be onsite needed
• Remote workdays require a stable, secure, quiet, and compliant workspace

Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.