EDI Support Specialist

Note: NO C2C or 1099

We are seeking an experienced Senior EDI Support Specialist with strong Healthcare Payer domain knowledge and hands-on experience supporting Facets-integrated claims processing environments. The ideal candidate will have expertise in L2/L3 EDI production support, HIPAA X12 transactions, Edifecs Suite, TriZetto HIPAA Gateway, and trading partner management.

The candidate will be responsible for monitoring, troubleshooting, and resolving EDI transaction issues across claims, enrollment, membership, provider, billing, and payment functions. Strong Facets claims experience, including 837 claims processing and 835 payment transactions, is mandatory.

Key Responsibilities

• Provide L2/L3 production support for healthcare payer EDI platforms integrated with Facets.
• Monitor, troubleshoot, and resolve EDI transaction failures, rejected files, data mapping issues, and reconciliation discrepancies.
• Support HIPAA X12 transactions, including enrollment, claims, eligibility, claim status, prior authorization, and premium payment.
• Troubleshoot 837 Professional, Institutional, and Dental claims and 835 claims payment/remittance transactions.
• Support Edifecs Suite, TriZetto HIPAA Gateway, BizTalk Server, and related integration environments.
• Perform root cause analysis (RCA), incident resolution, and preventive maintenance.
• Manage trading partner onboarding, connectivity, certification, testing, and production releases.
• Monitor SFTP file transfers, batch processing, and production EDI workflows.
• Write and execute SQL queries to investigate claims, enrollment, and transaction processing issues.
• Collaborate with business users, claims operations teams, vendors, and external trading partners to resolve production issues.
• Maintain operational documentation and ensure compliance with HIPAA EDI standards and service-level agreements.

Required Technical Skills

• Healthcare Payer Domain – 5+ years
• EDI L2/L3 Support – 5+ years
• HIPAA X12 Transactions – 5+ years
• Facets – 3+ years with hands-on claims experience
• Edifecs Suite – 3+ years
• TriZetto HIPAA Gateway – 3+ years
• Trading Partner Management – 3+ years
• BizTalk Server and API integrations
• SQL Server or Oracle
• Unix/Linux
• SFTP and batch processing
• XML/XSD and JSON

Mandatory HIPAA X12 Transaction Experience

Candidates must have hands-on experience supporting the following transactions:

• 834: Enrollment and maintenance
• 837P / 837I / 837D: Professional, Institutional, and Dental claims
• 835: Claims payment and remittance advice
• 270/271: Eligibility inquiry and response
• 276/277: Claim status inquiry and response
• 278: Healthcare services review and prior authorization
• 820: Premium payment
• TA1 / 999 / 277CA: EDI acknowledgements, claim acceptance, and rejection handling

Preferred Qualifications

• Experience supporting large-scale healthcare payer implementations and Facets environments.
• Knowledge of HL7/FHIR standards.
• Experience with ServiceNow, MuleSoft, or Boomi.
• Familiarity with Groovy, JavaScript, PowerShell, or Shell scripting.
• Strong analytical, troubleshooting, communication, and stakeholder management skills.