The Role
Owns and troubleshoots healthcare EDI workflows using Edifecs, including X12 transaction validation, mapping, partner requirements, error analysis, SQL reconciliation, and payer or state-system issue resolution. Documents integration requirements, supports audits and data quality controls, collaborates with technical and business stakeholders, and helps resolve architecture and operational issues. Requires extensive Edifecs, EDI, and HIPAA experience, plus eligibility for a Public Trust clearance.
Summary Generated by Built In
The SW Engineer Principal (Edifecs EDI Analyst Transaction Specialist) owns functional EDI workflows, partner requirements, and data validation rules. This role ensures accurate transaction processing and supports business operations. This is a 100% Remote role.
JOB DESCRIPTION
- Interpret and troubleshoot transaction sets: 270/271, 276/277, 278, 820, 834, 835, 837, 999/277CA.
- Analyze SNIP compliance, companion guides, and partner‑specific validation rules.
- Document mapping/logical requirements for new partners and integration changes.
- Partner with business stakeholders for issue resolution and operational impact assessments.
- Support audit/compliance reviews and maintain data quality guardrails.
- Collaborate with EDI Analysts, DevSecOps Engineers, cloud teams, and business teams.
Education
- Bachelor’s or master’s degree in computer science, engineering, or a related technical discipline required; equivalent practical experience considered.
- Edifecs certification.
Experience
- Minimum 8 years of Edifecs product experience in EDI, healthcare, or enterprise application operations.
- Minimum 8 years EDI/HIPAA experience.
- Strong understanding of payer/provider workflows.
- Ability to interpret loops/segments/element‑level errors.
- Familiarity with Edifecs Transaction Management or equivalent tools.
- Excellent communication and stakeholder engagement skills.
Requirements
Core Technical
- Strong Proficiency in X12 / HIPAA EDI Transactions structure, rules, and field-level details of the full 270/271, 276/277, 278, 820, 834, 835, 837, 999/277CA.
- Strong understanding of EDI X12 Loop/segment/element interpretation, SNIP validations (Levels 1–7), companion guide interpretation, and error analysis at segment or element level.
- Experience with interpreting Edifecs XEngine validation resultsm, understand processing rules and transaction profiles.
- Experience working with SpecBuilder maps and implementation guides.
- Able to identify issues sourced from Edifecs routes, profiles, or rulesets.
- Able to interpret Edifecs logs and error codes (functional layer, not platform admin level).
- Proficient with identifying root causes of transaction errors, resolving mapping mismatches, troubleshooting rejections from payers or state systems, and reviewing parsed EDI structures stored in SQL databases.
- Able to understand inbound/outbound workflow architecture
- Work with integration specialists on AS2, SFTP, HTTPS flows.
- Validate data sent to/received from non-X12 partners.
- Identify issues introduced by middleware layers or APIs.
- Query SQL for transaction details.
- Validate payloads, timestamps, statuses, and error flags.
- Reconcile mismatches between raw EDI and stored data.
Process & Soft Skills
- Strong ability to communicate technical architecture decisions and trade-offs to non-technical stakeholders.
- Experience gathering and translating business reporting requirements into technical data models.
- Comfortable driving ambiguous architecture decisions to resolution with limited direction.
- Experience with agile methodologies (Scrum, Kanban) and JIRA.
- Strong documentation habits with creating transaction flow documentation, error trend reports, escalations, and updating SOPs and partner reference guides.
Nice to Have
- Knowledge of HIPAA compliance requirements in cloud data architecture
- Experience with healthcare payer/PBM systems, clearinghouses, or pharmacy operations.
- AWS certification is a bonus.
Clearance Requirement: US Citizenship required with the ability to obtain and maintain a Public Trust clearance
About UsSAIC® is a premier mission integrator focused on advancing the power of technology and innovation to serve and protect our world. Our robust portfolio of offerings across the defense, space, intelligence, and civilian markets includes secure high-end solutions in mission IT, enterprise IT, engineering services, and professional services. We integrate emerging technology, rapidly and securely, into mission critical operations that modernize and enable critical national imperatives.
We are approximately 23,000 strong; driven by mission, united by purpose, and inspired by opportunities. SAIC is an Equal Opportunity Employer. Headquartered in Reston, Virginia, SAIC has annual revenues of approximately $7.3 billion. For more information, visit saic.com. For ongoing news, please visit our newsroom.
Skills Required
- Bachelor’s or master’s degree in computer science, engineering, or a related technical discipline, or equivalent practical experience
- Edifecs certification
- Minimum 8 years of Edifecs product experience in EDI, healthcare, or enterprise application operations
- Minimum 8 years of EDI and HIPAA experience
- Strong understanding of payer and provider workflows
- Ability to interpret loops, segments, and element-level errors
- Experience with Edifecs Transaction Management or equivalent tools
- Proficiency in X12 and HIPAA transaction structures, rules, and field-level details
- Experience with SNIP validations, companion guides, and error analysis
- Experience interpreting Edifecs XEngine validation results and processing rules
- Experience working with SpecBuilder maps and implementation guides
- Experience troubleshooting Edifecs routes, profiles, rulesets, mappings, payer rejections, and state-system rejections
- Ability to query SQL databases and reconcile raw EDI with stored transaction data
- Experience with AS2, SFTP, HTTPS, middleware, APIs, and inbound or outbound workflow architecture
- Experience gathering business reporting requirements and translating them into technical data models
- Experience with Agile methodologies, Scrum, Kanban, and JIRA
- Strong technical communication, documentation, stakeholder engagement, and problem-solving skills
- Knowledge of HIPAA compliance requirements in cloud data architecture
- Experience with healthcare payer, PBM, clearinghouse, or pharmacy systems
- AWS certification
- US citizenship and ability to obtain and maintain a Public Trust clearance
Am I A Good Fit?
Get Personalized Job Insights.
Our AI-powered fit analysis compares your resume with a job listing so you know if your skills & experience align.
Success! Refresh the page to see how your skills align with this role.
The Company
What We Do
Spectrum San Diego is a high tech security innovator, specializing in ultra-low-dose X-ray screening systems.
