EDI 834 Consultant

We need an expert in EDI-834 for 3 months contract ( this may be extendable) with following dimensions

This resource is expected to drive various integrations at Client’s end. He/she should be able to consult the product team and strongly collaborate with them for end-to-end integrations.

For example, if OKTA is there for the SSO integration, then this person must explore the business use cases and how OKTA can be useful for the client. He/she must be able to gather complete information, present it to the client team, and collaborate with various stakeholders for their queries and concerns, oversee and help while implementation wherever required.

We confirmed the person with the below skillset with stakeholders for this position,

• Detailed understanding of USA healthcare Medicare and Medicaid service
• 834 EDI loops and segments including situational segments
• Deep understanding of USA healthcare providers, member, health plans, and agent processes
• Understanding of HIPPA compliance, their implementation, and applications
• Knowledge about medicare part A, B, C processing
• Deep understanding of various files for members and CMS like MMR, TRR, BEQR, etc
• Understanding of various health care processes but not limited as below,
o Appeals and grievances
o Bidding of healthcare plan providers
o Payments, and premium calculations
o Supplemental benefits
o Claim knowledge