Healthcare EDI Consultant

Role: Healthcare EDI Consultant

Duration: Nashville, TN

Duration: 15 Months Contract with possibility of extensions

IRG Clients seeking an experienced NCPDP Healthcare EDI Consultant to support the design, development, implementation, and maintenance of healthcare data integration solutions, with a primary focus on NCPDP (National Council for Prescription Drug Programs) electronic data interchange (EDI) standards. The consultant will play a key role in implementing the PAS 53 post-adjudication standard within an existing EDI system, while also supporting PAS 45 transactions and related healthcare data exchange requirements.

The ideal candidate will have strong expertise in NCPDP EDI transactions, healthcare data integration, and the Software Development Life Cycle (SDLC). This role requires close collaboration with business stakeholders, technical teams, and project partners to translate business requirements into scalable, reliable, and compliant integration solutions.

Key Responsibilities

• Lead the technical design, development, testing, and implementation of healthcare EDI integration solutions.
• Support the full Software Development Life Cycle (SDLC) for implementing the NCPDP PAS 53 standard within the existing EDI system.
• Work extensively with NCPDP post-adjudication transactions, particularly PAS 53 and PAS 45.
• Design, develop, and maintain data integration and ETL solutions to support healthcare data exchange requirements.
• Analyze business and technical requirements and translate them into effective integration designs and technical specifications.
• Collaborate with cross-functional teams, including business stakeholders, developers, testers, and implementation teams, to ensure successful project delivery.
• Develop, enhance, and optimize EDI workflows, data mappings, transformation logic, and integration processes.
• Conduct code reviews and provide technical guidance to development teams, promoting coding standards and best practices.
• Perform troubleshooting, root cause analysis, and issue resolution for EDI transactions and data integration processes.
• Validate data accuracy, completeness, and consistency across healthcare data exchanges.
• Ensure integration solutions adhere to applicable NCPDP standards, healthcare data requirements, and organizational data governance practices.
• Support system testing, integration testing, user acceptance testing (UAT), deployment, and post-implementation activities.
• Assist with production releases, monitor integration performance, and resolve implementation-related issues.
• Prepare and maintain technical documentation, including design specifications, data mappings, test scenarios, and implementation procedures.

Required Qualifications

• Demonstrated expertise in NCPDP EDI standards and healthcare data exchange.
• Strong hands-on experience with NCPDP post-adjudication transactions, particularly PAS 53 and PAS 45.
• Experience supporting EDI implementation projects throughout the SDLC, including requirements analysis, design, development, testing, deployment, and maintenance.
• Experience developing and maintaining data integration solutions and ETL workflows.
• Ability to translate business requirements into technical designs and implementation solutions.
• Strong analytical, troubleshooting, and problem-solving skills.
• Excellent communication and collaboration skills when working with business and technical teams.

Preferred Qualifications

• Experience implementing or enhancing NCPDP standards within existing healthcare EDI systems.
• Experience leading technical design and development activities for complex integration projects.
• Familiarity with healthcare data quality, data governance, and compliance requirements.
• Experience with integration testing, production support, and deployment activities.
• Experience providing technical leadership, conducting code reviews, and guiding development teams.