Application Developer-Electronic Data Interchange (EDI)

Trigent Software Private Limited

Job Location:

Bengaluru - India

Monthly Salary: Not Disclosed

Posted on: 11 hours ago

Vacancies: 1 Vacancy

Job Summary

Expertise Healthcare Industry Knowledge: Strong understanding of utilization management prior authorization workflows and clinical coding systems including ICD CPT and HCPCS. Payer-Provider Dynamics: Familiarity with healthcare regulatory requirements and payer-provider & HIPAA Compliance EDI 278 Mastery: Deep expertise in the structure segments and loops of the EDI 278 transaction set used for healthcare service review requests. HIPAA Standards: Solid grasp of HIPAA transaction compliance and data privacy Handling & Interpretation Unstructured Data Extraction: Skilled in extracting relevant information from scanned faxes PDFs and other unstructured formats. Clinical Insight: Ability to interpret clinical documentation patient demographics provider credentials and requested & Transformation EDI Field Mapping: Experience in mapping extracted data to EDI 278 fields and standardized codes. Automation Tools: Proficiency in scripting (e.g. Python) and ETL platforms for data transformation and Proficiency Integration Platforms: Familiarity with EDI software healthcare integration engines and custom automation tools. OCR & File Formats: Understanding of OCR technologies and file formats like PDF and TIFF for digitizing faxed Assurance Validation & Testing: Ability to review and test EDI files for accuracy completeness and compliance before submission. Troubleshooting: Skilled in resolving mapping errors and data & Documentation Cross-Functional Communication: Effective communicator with clinical IT and operations teams to clarify requirements and resolve ambiguities. Process Documentation: Capable of documenting mapping rules workflows and audit trails for training and to Have FHIR Knowledge: Exposure to HL7 FHIR standards and their application in healthcare data exchange. Other EDI Transactions: Familiarity with additional HIPAA EDI files such as 837 (claims) 835 (remittance) 276/277 (claim status) and 270/271 (eligibility).