EDI Technical Architect - Innova Solutions : Job Details

Innova Solutions is immediately hiring a EDI Technical Architect.Position type: Permanent Duration: Fulltime Location: New Jersey, US As a EDI Technical Architect, you will:

• Lead configuration efforts for cross functional teams on multiple state implementations.
• Manage and coordinate code development and contract deliverables for one or more claims processing functional areas.
• Facilitate client, offshore and/or internal requirement and training sessions, including but not limited to;

Hosting calls with the development team to discuss design review issues, development status and testing.

Identify and/or review requirement changes if issues determined during development or testing. Determined and documented design changes needed to support requirement changes and reviewed with internal staff prior to submission and review with the client.

Reviewed conversion data loads reporting any issues or clarifications needed.

Hosted calls with the State staff to review and resolve design, testing and/or vendor issues.

Conduct Train the trainer sessions to train operations and State Staff members on functionalities of the MMIS system via the MMIS Web Portal.

Validate and/or create Lesson Modules. Developed training schedule an setup meetings. Create training agendas and practice exercise documents. Performed test data setup as required.

Provide onsite support for system implementation by reviewing processing alongside the State users, addressing issues encountered and determining resolutions as needed.

• Post implementation responsibilities include day-to-day functional area operations and the design, development, and implementation of processing issues and any requested changes.

Review daily and periodic reports and system alerts, host client meetings (weekly, monthly and adhoc) to discuss functional area processing issues with the State resources and applicable State vendors as well as discussions on development priorities, defect resolutions (both internal (HE) and external (State vendors or Source system staff) and upcoming client changes.

2.Reviewed and prioritized resolution of issues reported both internally and by the client.

• Managed the development of functional change requests (CRs) by gathering the requirements and designing the changes to the existing product design to meet and support new processing requirements.

Analyze the requirements and determine the scope of the processing and system configurations within pone or more functional areas that would be impacted to support the new requirements.

Create an Impact Analysis document detailing the design changes needed to support the State's requirements. This task required reviewing the existing configurations (system lists, parameters, etc.), processing specifications for each functional process impacted, reports, database changes and/or any new functionality that needs to be added. If updates are required across functional areas, I had to coordinate and consolidate the IA details for review with the State. Once the details of the requirements are reviewed and approved by the State the IA is submitted to the development and QA teams for their assessment (hours). The resulting Impact Analysis document would detail the system modifications needed along with the hours assessed for tasks performed by the SME, Development and QA teams. This document is submitted to the PMO for finalization and submission to the State.

• Create design changes by updating/adding rules, configuration requirements, new table specifications (if required), updates to specification documents (use case, interface, UI, exhibits, etc.). If changes were required across multiple functional areas coordinated with the respective SME to incorporate their respective area updates in the deliverables to the State.
• Schedule meetings with the State to walk through the details of the design changes for each area.
• Responsible for reviewing and resolving any design issues cited by the development team. Review unit test results and the test scenarios drafted by the QA team sending my approval and/or comments to each team. Review SIT test results as completed by the QA team, sending my approval for the developed code to be delivered for User Acceptance Testing or returned for any testing issues or code corrections determined.
• Where applicable developed implementation workplan detailing tasks required to implement large scale system changes. Most of these manual tasks required to allow processing to begin once the code was deployed.

Candidate must have skills:

• Re-engineer - Architect and design EDI transactions (270, 271, 276, 277, 278, 820, 834, 835, 837, 999, etc.
• Expert in designing and implementing end-to-end data warehouse architectures using modern ETL and Datawarehouse technologies, healthcare interoperability standards (X12, EDI, HL7, FHIR), and advanced analytics platforms to support data-driven decision making across healthcare systems.
• Work closely with the MMIS Team and Operations Team on various systems including Provider and Claims and the associated nightly/daily batch processes ensuring 24/7 operations.
• To be successful, the Technical Business Systems analyst must be a seasoned, experienced professional with a full understanding of systems analysis, production support, batch cycle processing, quality assurance, report development, query development, requirements gathering and documentation creation.
• Familiar with MMIS batch cycle processes, IBM Workload Automation, and ability to provide on-call Support (including evenings, weekends, and holidays.
• Experience with Optical Character Recognition (OCR) - Familiarity with healthcare claim OCR processes including daily balancing.
• Familiar with X12 mapping across multiple transaction types.
• Provide technical problem solving and deep solution expertise to the customer, QA and Development teams. Provide technical leadership, guidance, and help to drive the strategies proposed by the client and the Conduent team.
• Leverage hands-on customer experience and proof-points to educate and engage the broader community of prospects, customers, partners and coworkers.
• Support reporting needs of internal and external business users.
• Analyze business processes and performs needs assessments in an effort to align various information technology solutions with business initiatives.
• Interpret business needs and translates them into the different system requirements.
• Write business specifications and forwards to technical staff for development of the various systems.
• Interpret different systems specifications to develop, maintain and support automated business processes where applicable.
• Provide technical expertise in identifying, evaluating and developing systems and procedures that are cost effective and meet user requirements.
• Configure system settings and options, plans and executes acceptance testing, and creates specifications for systems to meet business requirements.
• Demonstrate good judgment in selecting methods and techniques for obtaining solutions.
• Network with senior internal and external personnel in own area of expertise.
• Operate with little instruction on day-to-day work and general instructions for assignments.
• Demonstrate analytical aptitude with attention to detail and proficiency with SQL Developer.

Qualifications Required:

• Bachelor's Degree or equivalent working experience.
• 5+ years of experience in developing and implementing Healthcare EDI Transactions.
• Must have experience in EDI Transformation projects.
• Must have working experience in architecting and designing EDI transactions (270, 271, 276, 277, 278, 820, 834, 835, 837, 999, etc.
• Requires a minimum of 7 years of production support.
• Requires a minimum of 10 years of related experience any of the following:

Healthcare functional area expertise - preferred in Claim Adjudication, Claim Payment, Member Enrollment & Eligibility.

Systems Analysis

Quality Assurance

Report Development

Query Development

Requirements Gathering

• Minimum 7 years of experience and understanding of large scale infrastructure deployments in enterprise-wide environments required.
• Minimum 5 years of experience in applications such as Azure, ReqPro, DOORS and ETL.

Preferred Qualifications For Consideration: This is nice to have or wish list. Experience on implementing or maintaining one or more claim processing functional areas in either a development/configuration setting or maintenance setting - desire work and details on minimally 3-5 initiatives. Must be able to provide adequate information on company, account and product ensure validation and limited background check.

• Intermediate to skilled proficiency in writing SQL queries.
• Ability to communicate effectively, successfully interact with internal and external stakeholders, work both independently and as part of a team, and work efficiently to handle competing priorities.
• Agile process experience
• Microsoft Tools Suite
• Provider MMIS Systems
• Claims MMIS Systems functional area expertise

Qualified candidates should APPLY NOW for immediate consideration! Please hit APPLY to provide the required information, and we will be back in touch as soon as possible. We are currently interviewing to fill this and other similar positions. If this role is not a fit for you, we do offer a referral bonus program for referrals that we successfully place with our clients, subject to program guidelines. ASK ME HOW. Thank you! Kiran Vajrala Manager PAY RANGE AND BENEFITS: Pay Range*: $ 96,500 - $ 113,500 Per Year *Pay range offered to a successful candidate will be based on several factors, including the candidate's education, work experience, work location, specific job duties, certifications, etc. Benefits: Innova Solutions offers benefits( based on eligibility) that include the following: Medical & pharmacy coverage, Dental/vision insurance, 401(k), Health saving account (HSA) and Flexible spending account (FSA), Life Insurance, Pet Insurance, Short term and Long term Disability, Accident & Critical illness coverage, Pre-paid legal & ID theft protection, Sick time, and other types of paid leaves (as required by law), Employee Assistance Program (EAP). ABOUT INNOVA SOLUTIONS:Founded in 1998 and headquartered in Atlanta, Georgia, Innova Solutions employs approximately 50,000 professionals worldwide and reports an annual revenue approaching $3 Billion. Through our global delivery centers across North America, Asia, and Europe, we deliver strategic technology and business transformation solutions to our clients, enabling them to operate as leaders within their fields. Recent Recognitions:

• Named One of America's Best Employers for New Grads by Forbes (2024)
• Named One of the Best Companies to Work For by U.S. News & World Report (Private Companies List, 2024-2025)
• One of the Largest IT Staffing Firms in the US - Ranked #3 by Staffing Industry Analysts (SIA, 2024)
• One of the Largest Staffing Firms in the US - Ranked #13 by Staffing Industry Analysts (SIA, 2024; includes Innova Solutions, Volt, & HireGenics)
• Named One of the Top Ten Private Companies in Atlanta by the Atlanta Business Chronicle (2023)
• One of the Largest Certified Minority Business Enterprises (MBEs) in the United States (NMSDC, 2024)
• AWS Advanced Tier Services Partner with 100+ certifications

Website: Innova Solutions is an Equal Opportunity Employer and prohibits any kind of unlawful discrimination and harassment. Innova Solutions is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment on the basis of race, color, religion or belief, national origin, citizenship, social or ethnic origin, sex, age, physical or mental disability, veteran status, marital status, domestic partner status, sexual orientation, or any other status protected by the statutes, rules, and regulations in the locations where it operates. If you are an individual with a disability and need a reasonable accommodation to assist with your job search or application for employment, please contact us at [email protected] or (770) ###-####. Please indicate the specifics of the assistance needed. Innova Solutions encourages all interested and qualified candidates to apply for employment opportunities. Innova Solutions (HireGenics/Volt) does not discriminate against applicants based on citizenship status, immigration status, or national origin, in accordance with 8 U.S.C. § 1324b. The company will consider for employment qualified applicants with arrest and conviction records in a manner that complies with the San Francisco Fair Chance Ordinance, the Los Angeles Fair Chance Initiative for Hiring Ordinance, and other applicable laws.