Electronic Data Interchange Developer

Title: EDI Developer Location: Remote Job Type: Contract-to-Hire Position Summary: The EDI Developer is responsible for designing, developing, and maintaining healthcare data exchange solutions with providers, payers, pharmacy benefit managers (PBMs), and other partners. This role involves working extensively with ANSI X12 and HIPAA-compliant transactions to support claims, eligibility, billing, pharmacy, and enrollment processes. You’ll collaborate with both technical and business teams to ensure data integrity, regulatory compliance, and optimal system performance—while mentoring junior developers and supporting broader data governance initiatives. Key Responsibilities Data Collaboration & Governance • Partner with source systems, data stewards, and business teams to ensure effective data governance and resolve data quality or integration issues • Translate business requirements into scalable data exchange solutions • Mentor and provide guidance to junior analysts and developers Data Exchange Development • Design, build, and maintain EDI maps and workflows for transactions with healthcare entities • Work with ANSI X12 and HIPAA standards (834, 837, 835, 270/271, 276/277) and NCPDP pharmacy standards • Collaborate with PBM and payer partners to streamline claims, eligibility, and formulary processes Systems Compliance & Performance • Ensure compliance with HIPAA, CMS, and other healthcare regulations • Monitor, troubleshoot, and optimize EDI transactions and system connectivity • Improve data reliability, accuracy, and workflow performance Master Data & Process Management • Support Master Data Management (MDM) initiatives, including defining governance processes and data standards • Collaborate with database and network administrators to resolve integration issues • Document integration processes, configurations, and mappings for knowledge continuity Qualifications • Bachelor’s degree in Information Technology, Computer Science, or related field (or equivalent experience) • 5+ years of experience in systems integrations and/or ETL development (Informatica, SSIS, or similar tools) • 3+ years of hands-on EDI development experience in the healthcare or PBM industry • Strong experience with flat file integrations, FTP/SFTP, and data transformation • Proficiency in SQL (SQL Server preferred) and experience in Master Data Management concepts • Knowledge of mapping tools, XML/XSLT, scripting, and integration frameworks • Familiarity with data warehouse concepts and Power BI reporting • Understanding of data encryption, APIs, and cloud-based integrations (preferred) • Excellent problem-solving, analytical, and communication skills • Ability to work both independently and collaboratively in a remote environment