Job ID: 1894
Position Overview
We are looking for a seasoned Facets EDI Consultant with a specific focus on EDI 837 transactions to join our healthcare technology division. This is a remote contract role that requires a deep understanding of the Trizetto Facets platform and the intricate world of healthcare EDI standards. You will be responsible for ensuring that our claims processing systems are efficient, compliant, and capable of handling high volumes of data from various trading partners and clearinghouses. As an Facets EDI Consultant you will be a part of an Agile team to build healthcare applications and implement new features while adhering to the best coding development standards.
Primary Responsibilities
- Lead the analysis, design, and implementation of EDI 837 (Professional, Institutional, and Dental) transaction sets within the Facets environment.
- Configure and optimize Facets EDI workflows, including the setup and maintenance of pre-scrub engines to validate claims before they enter the core system.
- Act as the primary technical contact for clearinghouses and trading partners, resolving connectivity and data mapping issues in a timely manner.
- Ensure all EDI transactions are fully compliant with HIPAA regulations and X12 standards, maintaining the security and privacy of protected health information (PHI).
- Develop and execute comprehensive test plans for EDI transactions, including unit testing, integration testing, and end-to-end system testing.
- Utilize SQL to perform data analysis, troubleshoot processing errors, and generate reports on claim volumes and rejection rates.
- Collaborate with business stakeholders to define requirements for new EDI features and system enhancements.
- Document all EDI mapping logic, configuration settings, and operational procedures to ensure knowledge transfer and system maintainability.
- Participate in Agile development cycles, contributing to sprint planning, daily stand-ups, and retrospective meetings.
- Provide subject matter expertise on US healthcare payer operations, including enrollment, billing, and claims adjudication processes.
Required Expertise
- Extensive experience (5-8 years) in EDI analysis and implementation within the healthcare industry.
- In-depth knowledge of the Trizetto Facets platform and its EDI modules.
- Mastery of HIPAA transaction sets, particularly 837, 835, 270/271, 276/277, and 834.
- Strong SQL skills for data querying and manipulation.
- Familiarity with EDI translation tools and middleware.
- Excellent problem-solving skills and the ability to analyze complex data structures.
- Strong communication skills, both written and verbal, for effective collaboration with remote teams.
Remote Work Environment
As a remote consultant, you will be expected to maintain a high level of productivity and self-management. You will use modern collaboration tools like Slack, Microsoft Teams, and Jira to stay connected with the team and track project progress. This role offers the flexibility of working from home while contributing to critical healthcare infrastructure projects that impact millions of members.
Future Outlook
The healthcare industry is constantly evolving, with new regulatory requirements and technological advancements emerging regularly. In this role, you will have the opportunity to stay at the cutting edge of these changes, helping our organization adapt to new standards like FHIR and real-time claim adjudication. We value consultants who bring a forward-thinking mindset and are eager to contribute to the long-term success of our healthcare technology roadmap. Your work will directly contribute to the accuracy and efficiency of our claims processing engine. By optimizing EDI workflows and reducing claim rejections, you will help improve provider satisfaction and ensure timely payments.
Special Requirements
Contract mode; Remote; Requires deep understanding of US Healthcare payer operations and HIPAA EDI protocols.
Compensation & Location
Salary: $125,000 – $175,000 per year (Estimated)
Location: Remote
Recruiter / Company – Contact Information
Recruiter / Employer: VBeyond Corporation
Email: sophiar@vbeyond.com
Recruiter Notice:
To remove this job posting, please send an email from
sophiar@vbeyond.com with the subject:
DELETE_1894