Job Description

Job Description

Job Description

Salary:

We are seeking a skilled EDI Consultant with specialized experience in healthcare claim transactions to support our Data Integration (DI) Review & Validation efforts. The ideal candidate will have a strong background in 837P professional claim formats and CMS-1500 form mappings, with the ability to assess and validate system logic against payer-specific requirements.

Key Responsibilities:

• Conduct detailed reviews of 837P (Professional) EDI transactions to ensure data integrity and format accuracy.
• Validate mappings to CMS-1500 claim forms, ensuring alignment between electronic and paper-based formats.
• Review and confirm correct population of provider fields (e.g., Rendering NPI, Supervising NPI) at both line-item and claim levels.
• Identify, document, and communicate any gaps, mismatches, or inconsistencies between system-generated data and payer requirements.
• Collaborate with cross-functional teams (EDI developers, business analysts, QA) to provide feedback and recommend corrections.
• Participate in user acceptance testing (UAT) and post-deployment validation to ensure implementation success.
• Stay updated on HIPAA EDI standards and payer-specific guidelines related to 837P/CMS-1500 submissions.

Required Qualifications:

• Proven experience working with 837P transactions and CMS-1500 claim formats.
• Strong understanding of HIPAA EDI standards, claim data elements, and provider field logic.
• Hands-on experience with claim validation tools, EDI mapping, and system configuration review.
• Familiarity with payer-specific submission requirements and business rules.
• Ability to analyze large data sets and identify discrepancies or issues efficiently.
• Excellent documentation, communication, and collaboration skills.

Preferred Qualifications:

• Experience with clearinghouses or payers.
• Familiarity with 837I or other transaction sets (e.g., 835, 999, 277CA).
• Prior work with EHR/EMR or billing system integrations.

Job Tags

Similar Jobs