Healthcare EDI Technical Specialist - 6 Months Contract

The U.S. health sector is complex and dynamic - a vast and diverse network of entities that impacts the population and economy like no other industry. At USD$4.1 Trillion, healthcare spending represents nearly 18% of U.S. GDP. It is complex and inefficient. Health service buying, selling, and settlements have seen little change in the past decade despite clear changes in available information, technology, regulation, and market consolidation.

Enter MacroHealth. MacroHealth is a mission-driven company. We are building the most advanced and trusted market platform for health service payers and providers. The company’s vision is to create Intelligent Health Markets by building technology, knowledge and relationships that enable payers and providers to optimize the buying and selling of health services.

We are expanding our team of passionate thought leaders as we pursue our goal of disrupting the U.S. health sector with our vision and technology. We are committed to developing leading edge solutions in a supportive environment focused on customer success and employee fulfillment. 

$70-90/hour. This is a 6 months full-time contract. Start date: February 2023.

MacroHealth has exciting opportunities for multiple customer facing EDI Technical Specialists with a design and implementation focus. The ideal candidates will have experience with EDI and Data Exchange analysis and workflow design. You must have experience working with or directly for a Health Plan Commercial Payer. 

 
In addition, you are a self-starter with the ability to take ownership, work with tight timelines, and handle various tasks simultaneously while continuing to develop a positive work culture. 
Responsibilities: 

• As a SME, provide EDI and industry knowledge-sharing across all of the company teams 
• Work closely with Healthcare Payers and Networks to understand their operational and technical integration requirements to create data exchange specifications and requirements to support health plan data integrations 
• Work with customer (payers), networks and partners to define requirements and design integration solutions 
• Produce documentation to achieve high quality integrations 
• Maintain a deep understanding of the company's platform product capabilities 
• Assist with internal testing and work closely with customers during UAT phase of implementation projects 
• Build and continuously optimize implementation processes and procedures 
• Work closely with Product Management to provide input and feedback on platform features and functionality to support building customer integrations. 
• Proactively work to identify new features required to optimize integrations 
• Participate actively in Scrum related activities, including sprint planning and grooming. 
• Work closely with engineers to provide clear requirements for building customer integrations 
• Build and test customer integrations and documentation 

• 5+ years' experience as a software Systems Analyst or Business Analyst, gathering/documenting business requirements and translating into technical specifications. 
• 3+ years' experience working in a US Health Plan Commercial Payer environment. 
• Expert understanding of HIPAA transaction sets like 837,834. 
• Hands-on experience with HIPAA logical mapping and system implementation. 
• 3+ years' experience in an external, client facing role 
• Experienced in Claims Processing, Benefit Enrollment, Medical/Pharmacy encounter processing, Trading Partner enrollment, Provider enrollment, and resolving provider's claims-related issues 
• Experience analyzing, designing, and maintaining Business process Workflows. 
• Experience with Troubleshooting and resolving EDI and other Data issues in a production environment 
• 835 implementations including non-compliance remediation; diagnosis, root cause identification, remediation recommendation, implementation, and testing. 
• General knowledge of healthcare operations, payer business processes and provider and EDI infrastructures. 
• Experience with building cloud services or SaaS technologies. Strong knowledge of and aptitude for cloud computing principles. 
• Ability to develop strong working relationship with engineering and stakeholder groups, and the curiosity and skill to dig deeper into requirements and the "why " with limited guidance. 
• BS in Computer Science/Information Systems or equivalent experience. 
• Excellent oral, written documentation, and presentation abilities. 

Your Background May Additionally Include: 

• MS in Computer Science/Information Systems 
• Claims, enrollment, and pricing configuration experience 
• EDI QA experience 

 

More about us

MacroHealth is a highly collaborative work environment where each team member can rely on the skills, expertise, and support of one another across the company. We operate with an open-door policy and are wide open to new perspectives for improving our operations and fueling future growth with a diverse and engaged team.  

How we protect team member health and safety 

At MacroHealth we recognize the impacts of the global pandemic have taken shape differently for each of us based on our role, our location, our family situations, and job transitions. Health, safety and wellbeing are top of mind for us in supporting safe office environments as well as engaging team members working from home. As part of this approach, a vaccination policy has been implemented requiring all eligible employees to be fully vaccinated against COVID-19 in order to work in one of our offices or travel to client locations. 

Diversity, Equity, and Inclusion 

We are committed to facilitating constructive team member engagement and promoting a respectful work environment. We design our company processes to surface necessary conversations, engage multiple voices, remove barriers, and recognize contributions made at every level. We actively promote practices to create lasting change and partner with organizations that align with our values.

This role requires legal authorization to work in US.

MacroHealth is an equal opportunity employer.