Note: The job is a remote job and is open to candidates in USA. Ekfrazo Technologies Private Limited is seeking a Senior Healthcare EDI Integration Engineer with expertise in healthcare EDI and AWS infrastructure. The role involves managing EDI transactions, system administration of claims platforms, and developing automation scripts to enhance operational efficiency.
Responsibilities
- Assess, plan, and execute new business implementation and integration projects concerning EDI transactions, including but not limited to 834, 835, 837, 270/271, 276/277
- Manage and monitor daily processing of healthcare claims, eligibility and provider files (e.g., 834, 837, 835, 270/271, and 276/277), ensuring timely intake, validation, and staging for downstream processing
- Facilitate comprehensive discussions with vendors and internal stakeholders to gather, analyze, and document detailed requirements for EDI and encounter implementations
- Work with customers’ technical team to create detailed technical standards-based data interface specifications ensuring customer’s technical team can effectively implement the interface to satisfy business objectives. Implement Birdsong’s interface
- Understand EDI mapping documents, manage communication with partners and assist in producing operational documents
- Establish and maintain relationships with external/internal partners, clients, and vendors to facilitate seamless EDI transactions
- On a monthly basis, perform member eligibility audits comparing incoming plan data (834) to system data to ensure data integrity reporting results back to leadership
- Analyze, design and develop specifications for enhancements and extensions to electronic data interchange application interfaces
- Manage and publish new FHIR APIs as needed
- Manage user access and permissions in alignment with security and compliance requirements
- Coordinate OS updates, patches, and security hardening to servers following internal IT policies
- Configure and maintain scheduled jobs, background services, and automated tasks required for internal system operations
- Serve as the primary technical owner of the claims system, including file ingestion, transformation, delivery pipelines, exports, conversions, encryptions and transfers
- Coordinate with other IT teams (e.g., infrastructure, desktop support, security, identity management) to maintain and troubleshoot claims system infrastructure, ensuring high availability and performance of all related servers and services
- Proactively monitor system health and performance; respond to alerts and incidents to ensure minimal disruption to eligibility and claims processing
- Support SFTP connections and AWS lambda functions and folder structures plus S3 and Transfer Family
- Troubleshoot and resolve technical errors/incidents
- Assist with ETL process to migrate business to another platform
- Develop, maintain, and enhance in-house automation scripts to support claims workflows, eligibility processing, and client-specific integrations
- Identify opportunities for process automation and implement solutions to improve operational efficiency and reduce manual intervention
- Lead technical onboarding for new clients, including AWS SFTP setup, EDI, file format validation, test file processing, and automation configuration
- Test new file transmissions to ensure accuracy of client implementation in lower test environments. Prepare and maintain test data
- Collaborate with client IT teams to ensure secure and accurate data exchange protocols are in place
- Act as the primary point of contact for external vendors (e.g., clearinghouses) to resolve file transmission, data issues or system integration issues
- Troubleshoot production and lower environment issues collaborating with vendor and other technical and business staff as needed
- Work closely with internal stakeholders including the claims team, business operations, and finance to support audits, reporting, and issue resolution
- Keep leadership abreast of critical issues with timely updates as needed
- Support SOC and internal audit readiness by gathering and providing technical evidence related to claims systems, file processing, and automation workflows
- Ensure compliance with HIPAA, data security standards, and internal IT policies
- Work with IT leadership to develop and maintain disaster recovery (DR) procedures for claims systems and related infrastructure to ensure business continuity
- Conduct regular DR testing in coordination with IT leadership and business stakeholders to validate recovery processes and system resilience
- Document recovery steps and ensure all critical systems and automation workflows are included in DR planning
- Develop and continue to revise technical documentation representing the architecture, inbound and outbound data flows for every client, and technical details related to the systems
Skills
- 4–7 years' of experience in IT operations or systems engineering
- 2+ years' supporting an application platform
- 2+ years' EDI technical support experience within healthcare payer organization or TPA
- 2+ years' experience in AWS infrastructure. Demonstrated experience and knowledge with SFTP connections and AWS lambda functions and folder structures plus S3 and Transfer Family
- Expert in all EDI file formats: 837: Health Care Claim, 835: Health Care Claim Payment/Advice, 270/271: Eligibility Inquiry and Response, 999 and 276/277: Claims Status Inquiry and Response, 834: Benefit Enrollment and Maintenance
- Strong experience writing and troubleshooting complex SQL
- Proficiency in scripting languages (e.g., Python, PowerShell, Bash) and automation tools
- Experience with file transfer protocols, and secure data exchange
- Familiarity with claims clearinghouses (e.g., Waystar) and staging processes
- Knowledgeable across a broad set of infrastructure platforms (commodity hardware, Windows OS, Linux OS, etc.)
- Understanding of different file feeds and data exchanges with business customers and/or partners
- Skilled in tracking and assisting with prioritization of daily technical work in collaboration with business leaders
- Excellent verbal and written communication skills
- Demonstrated ability to manage multiple priorities and support organizational change
- Excellent analytical, research, investigation and troubleshooting skills
- Knowledge/application of standard security protocols for electronic data transmissions
- Ability to relate or explain technical information to non-technical staff
- Ability to collaborate with vendors
- Knowledge of HIPAA law and ability to adhere to HIPAA standards and ability to apply standards of protected health information exchange
- Ability to solve a diverse range of complex problems, working with limited direction
- ETL experience migrating data from one system to another using AWS tools (e.g. Data Brew, Glue)
- Experience in developing RESTful APIs, using programming languages like Java, Python or .NET
- Understanding of the technical aspects of healthcare payer systems and/or third-party administrators is preferred
- 1+ years' experience managing and publishing FHIR APIs. Strong understanding of FHIR standards, profiles, and best practices
- Experience supporting SOC and HIPAA audits by gathering technical evidence and ensuring compliance with internal controls
Company Overview
Businesses move faster when their tech partner actually understands what they're building. It was founded in 2015, and is headquartered in Bengaluru, Karnataka, IND, with a workforce of 201-500 employees. Its website is https://ekfrazo.com.