Company Overview:

Join us in our mission to transform healthcare! RxAdvance, now doing business as nirvanaHealth, is committed to bringing the art of possible to the payer and PBM industries, which is why we strive to invest in our employees throughout all stages of life. Success radiates through all levels of employees here, with competitive benefits, a strong focus on employee wellness, and optional education courses offered through UDEMY: we aim to support all aspects of employee growth.

Characterized by curiosity, innovation, and an entrepreneurial mindset, nirvanaHealth is the first to offer medical and pharmacy benefit management solutions that run on the same platform, made possible by our creation, Aria – the first robotic process automation cloud platform designed for healthcare.

Led by our chairperson John Sculley (former Apple CEO) and noted healthcare entrepreneur and founder of ikaSystems Ravi Ika, nirvanaHealth endeavors to sizably reduce the $900 billion in waste in healthcare administrative and medical costs. We are seeking A-players to join our team – folks who embrace the grind and hustle of a growing company, are collaborative and innovate, are life-long learners and growers, and have an entrepreneurial and positive mindset.

Job Summary

Working under the direction of the Manager, Business Systems & Data, the EDI Specialist is responsible to 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. The EDI Specialist will work with operations team members to identify and manage cross-team dependencies to align with developing solutions, delivering platform requirements, and defining acceptance criteria.

Job Responsibilities (but not limited to):

• Analyze, design, develop, test, troubleshoot, optimize, enhance, and maintain EDI applications in various formats that include HIPAA standard formats such as 837 and 834 and other regulatory formats using EDI mapping tools.
• Troubleshoot enterprise solutions in a healthcare environment.
• Work cross departmentally between implementation, operations, and technology teams to ensure file accuracy and completion.
• Implement and monitor EDI systems, including data mapping, translation, and interface.
• Design and maintain all EDI maps to ensure compliance to all business requirements.
• Participate in all system smoke tests and analyze all data and processes and recommend improvements to same.
• Other duties as assigned.

Qualifications:

Education and/or Training:

• Bachelor of Science in Computer Applications, Computer Science, Engineering, or similar fields required.

Professional Experience:

• Minimum of 3 – 5+ years of experience in the designing, deploying, monitoring, configuring and troubleshooting of enterprise solutions in a health care environment.
• Must have recent experience with HIPAA EDI transactions including EDI X12 270, 271, 276, 277, 278, 820, 834, 835, 837.
• Good depth with RDBMS such as Oracle, SQL, PL/SQL.
• Familiarity with iterative development life cycle and methodology.
• Understanding of PDEs.
• Medicare and Medicaid eligibility relevancy (preferred).

Technical Skills:

• Strong PC skills; MS Word, Excel, Access, and Power Point, PL/SQL, Oracle DB, SQL

Additional Considerations:

• Applicants must be able to pass a background investigation as all offers are pending a successful completion of background check per the company policy.

Job Types: Full-time, Part-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 4 hour shift
• 8 hour shift
• After school
• Choose your own hours
• Day shift
• Monday to Friday

Ability to commute/relocate:

• Southborough, MA 01772: Reliably commute or planning to relocate before starting work (Required)

Work Location: In person

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