Key Responsibilities
- Design, develop, configure, and maintain Edifecs applications and healthcare EDI interfaces.
- Develop and support HIPAA transaction processing including 834, 835, 837, 270/271, 276/277, and 278 transactions.
- Configure and maintain Edifecs modules such as XEngine, SpecBuilder, Transaction Management, and Smart Trading Partner Management (STPM).
- Analyze business requirements and translate them into technical solutions.
- Create mapping specifications and validation rules for inbound and outbound healthcare transactions.
- Troubleshoot production issues, perform root cause analysis, and resolve data integration problems.
- Collaborate with business analysts, product owners, vendors, and operations teams to improve EDI workflows.
- Support testing activities including unit, integration, regression, and user acceptance testing.
- Ensure compliance with HIPAA regulations and healthcare industry standards.
- Develop technical documentation, design documents, and support procedures.
Required Qualifications
- Bachelor's degree in Computer Science, Information Systems, Healthcare Informatics, or related field.
- 3+ years of Edifecs development experience in a healthcare payer environment.
- Strong experience with Edifecs XEngine, SpecBuilder, Translator, and STPM.
- Knowledge of HIPAA EDI transactions (834, 835, 837, 270/271, 276/277, 278).
- Experience with XML, X12 EDI, SQL, Java, and Web Services.
- Familiarity with healthcare claims, enrollment, provider, and eligibility processes.
- Experience troubleshooting production support issues and implementing fixes.
- Strong analytical, problem-solving, and communication skills.
Preferred Qualifications
- Experience working with Medicare, Medicaid, and Commercial Health Plans.
- Knowledge of FHIR APIs and modern healthcare interoperability standards.
- Experience with cloud platforms such as Azure or AWS.
- Healthcare payer or managed care industry experience.
- Edifecs certification preferred.
Technical Skills
- Edifecs XEngine
- SpecBuilder
- STPM
- Transaction Management
- X12 EDI
- HIPAA Transactions
- XML/XSLT
- SQL
- Java
- REST/SOAP APIs
- Healthcare Claims Processing
- Eligibility & Enrollment Systems
Salary Range
Now, a little about us …
At Tegria, we bring bold ideas and breakthroughs to improve care, technology, revenue, and operations in ways that move healthcare organizations from patient-centered to human-centered. We are helping healthcare put people first—both patients and those who dedicate their lives to delivering care.
And at the very core of this vital work is our incredibly talented people.
People with different backgrounds who welcome challenge and change. People who listen first, ask hard questions, and make decisions to cultivate a culture of equity and inclusion. People who chase after goals, growth, and generosity. We’re real. We’re nimble, and we believe in our mission to humanize healthcare.
Perks and benefits
Top talent deserves top rewards. We’ve carefully curated a best-in-class benefits package, meant to meet you wherever you are in your life and career.
Your health, holistically. We offer a choice of multiple health and dental plans with nationally recognized networks, as well as vision benefits, a total wellness program, and an employee assistance program for you and your family.
Your financial well-being. We offer competitive wages, retirement savings plans, company-paid disability and life insurance, pre-tax savings opportunities (HSA and/or FSA), and more.
And everything in between. Our lifestyle benefits are unrivaled, including professional development offerings, opportunities for remote work, and our favorite: a generous paid-time-off program, giving you the flexibility to plan a vacation, take time away for illness (or life’s important events), and shift your schedule to accommodate those unexpected curve balls thrown your way.
Tegria is an equal employment opportunity employer and provides equal employment opportunities (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. All qualified candidates are encouraged to apply.
