PlanStreet offers versatile case management software for health and human service non-profits, empowering teams with automation, customization, and secure access to information.

PlanStreet

Healthcare EDI (X12 837/835) Developer


------------------------------------------

### **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.