Healthcare Beneficiary Eligibility SME

Softrams is one of the fastest growing digital services firms in the Washington Metropolitan regions crafting human-centered solutions and empowering digital services with a focus on HX, AI, cloud, DevOps and cyber security. Our offices are located in Leesburg VA, Baltimore MD, and Plano TX, and our teams are spread across the U.S.

Recognized as a Top Workplace USA (2024)Recognized as one of the Top Workplaces in Technology (2023, 2021) *INC 5000, Fastest growing companies in America (2023, 2022) Washington Business Journal Top 75 Fastest Growing Companies in Greater Washington area *2020 NXT UP - Top Federal Emerging Technology and consulting firms *2020 Inaugural DC Metro’s Most Successful Companies *2020 Washington Technology Fast 50 *NVTC Tech 100 (2020, 2019) *

**Job Description: Softrams is looking for a X12 EDI Healthcare Beneficiary Eligibility SME with experience in beneficiary eligibility transactions and healthcare benefits policies. The ideal candidate needs to be a subject matter expert who can bring their knowledge specifically in compliance dealing with eligibility/benefits inquiry verification (EDI 270/271) and related healthcare EDI transactions. The individual will be part of a collaborative and agile team that supports and builds modern, usable, and responsive applications for mission-critical U.S. federal government health IT solutions. NOTE: We kindly request that you do not apply if you are unable to meet the requirements for years of experience, or unable to meet the requirements for obtaining a U.S. Federal Position of Trust clearance designation.

Federal Requirements:  

• Ability to obtain a U.S. Federal Position of Trust clearance designation. 
• Must reside in and be able to perform work in the United States. 
• Must have lived in the United States for 3 of the last 5 years. 

Basic Qualifications:

• Bachelor’s degree in information technology, computer science or related discipline.
• 8 or more years of experience in related positions including as a SME, policy analyst, data engineer, product analyst, product manager and other software and application development work.
• Minimum 3-5 years of working experience working directly with HIPAA (Health Insurance Portability and Accountability Act) rules requirements for health plans, healthcare clearinghouses and healthcare providers in transmitting claims and other patient-identifiable health information in specific X12 EDI healthcare transaction sets.
• X12 5010A1 experience with real-time applications is essential. Broad experience with a variety of X12N transactions is preferred.
• Involvement and deep understanding of X12N (including workgroups), CAQH CORE and/or HL7 FHIR relevant to benefit eligibility is strongly preferred.
• Experience engineering and/or implementing SOAP and/or REST connectivity for real-time eligibility transactions is highly desirable.
• Experience with high availability, multi environment AWS implementations that process 24/7/365 highly preferable. Experience with fully redundant, high volume (billions annually) applications is highly desirable.
• Experience working with agile teams.

Responsibilities:

• Attend and participate in standards/sanctioning workgroups across the healthcare EDI industry. Actively participate in development of these standards with an eye towards representing federal government interests. Provide guidance and feedback to business stakeholders regarding key standards initiatives.
• Perform impact assessments on upcoming standard changes, in identifying necessary changes to the program and work within the team and stakeholders to implement timely modifications to the system.
• Identify and communicate changes to the EDI 270/271 transactions to prepare end user and various stakeholders on upcoming standard changes.
• As a Federal initiative identify ways to securely improve medical provider information, expedite the claims processing cycle and preserve the Medicare endowment. Applicants must work with various stakeholders to actively protect beneficiary information, in exceeding federal security.
• Evaluates business processes and operations by implementing subject expertise, identifies problem areas, and provides relevant business solutions.
• Offers guidance and required knowledge to product teams during the software development life cycle.
• Analyze eligibility/benefits inquiry to identify trends and gaps to the EDI 270/271transaction.
• Offer consulting services, contribute to specialized knowledge, and provide mentorship and training to teams.
• Verifies business and technical information, including the training manuals, user guides, and system requirements.
• Publicize important information and documents processes to stakeholders.
• Performs hands-on basic data query and exploratory analysis work and/or guides others in needed data analysis and interprets findings.

Benefits and Perks:

• 65%-75% company-sponsored (including dependents) premiums for medical, dental and vision insurance. For eligible plans and tiers, we provide 100% company-paid medical insurance. 100% employer sponsored STD, LTD and life insurance (min $100K). Voluntary life insurance option available.
• Retirement 401(k) plan with employer matching. Immediate vesting.
• Vacation and sick leave.
• Maternity and parental leave.
• Discretionary bonuses, spot awards, gifts, and tenure-based rewards.
• Company-sponsored role-based training and certifications.
• Monthly Doordash DashPass subscription.
• Group discounts via LifeMart ADP