Healthcare EDI (X12 837/835) Developer

Healthcare EDI (X12 837/835) Developer

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PlanStreet Inc. - Lexington, Kentucky (Remote)

We are seeking an experienced Backend Developer with strong expertise in healthcare EDI transactions, specifically X12 837 (Claims) and X12 835 (Remittance Advice). The ideal candidate will design, develop, and maintain backend systems for processing high-volume healthcare claims and remittances using C#, .NET, and SQL Server, ensuring compliance with HIPAA and industry standards.

Responsibilities:

EDI & Healthcare Transactions

• Design, implement, and maintain processing of X12 EDI 837 Professional, Institutional, and Dental claims.
• Implement parsing, validation, transformation, and posting of EDI 835 remittance advice.
• Handle claim lifecycle workflows including submission, acknowledgments (999/277CA), adjudication, and payment posting.
• Ensure compliance with HIPAA, X12 standards, and payer-specific implementation guides.
• Support error handling, rejection management, and reconciliation of claims and remittances.

Backend Development

• Develop and maintain backend services using C# and .NET / .NET Core.
• Design efficient and scalable SQL Server schemas, stored procedures, and queries.
• Optimize batch processing for high-volume EDI files.
• Build APIs and background services for EDI ingestion and outbound processing.
• Implement logging, monitoring, and audit trails for EDI transactions.

Integration & Data Processing

• Integrate with clearinghouses, payers, and external healthcare systems.
• Process inbound and outbound files via SFTP, APIs, or EDI gateways.
• Implement data mapping between EDI segments and internal application data models.
• Support file batching, splitting, merging, and scheduling.

Quality, Security & Compliance

• Perform unit, integration, and regression testing of EDI workflows.
• Ensure PHI security, encryption, and access control.
• Support compliance audits and production issue resolution.
• Maintain technical documentation for EDI processes and system architecture.

Requirements:

• 5+ years of backend development experience using C# and SQL Server.
• Strong hands-on experience with X12 EDI standards, specifically:
• • 837 (Professional, Institutional, Dental).
  • 835 (Remittance Advice).
• Solid understanding of healthcare revenue cycle management (RCM).
• Experience with HIPAA compliance and healthcare data security.
• Proficiency in SQL Server performance tuning, indexing, and stored procedures.
• Experience processing batch files and large datasets.
• Familiarity with SFTP, EDI translators, and clearinghouse integrations.

Nice to Have:

• Experience with 999, 277CA, 270/271, and 276/277 EDI transactions.
• Knowledge of payer-specific EDI rules.
• Experience with Azure Integration Account and Logic App X12 Connector.
• Familiarity with microservices architecture.
• Experience with EDI validation tools or translators.
• Healthcare domain certifications or prior payer/clearinghouse experience.

Soft Skills:

• Experience with 999, 277CA, 270/271, and 276/277 EDI transactions.
• Knowledge of payer-specific EDI rules.
• Experience with Azure Integration Account and Logic App X12 Connector.
• Familiarity with microservices architecture.
• Experience with EDI validation tools or translators.
• Healthcare domain certifications or prior payer/clearinghouse experience.