Urgently Hiring: Experienced Healthcare Provider Data Subject Matter Expert (SME) - EDI 270/271 Transactions and Healthcare Benefits Policies

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Awards and Recognition

Softrams has received numerous accolades for our work and company culture:

• 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 Summary

We're seeking an experienced Healthcare Provider Data Subject Matter Expert (SME) to join our team. As a Healthcare Provider Data SME, you will be responsible for providing expertise in EDI 270/271 transactions and healthcare benefits policies. You will work closely with our agile team to support and build modern, usable, and responsive applications for mission-critical U.S. federal government health IT solutions.

Key Responsibilities

• Attend and participate in standards/sanctioning workgroups across the healthcare EDI industry, representing federal government interests and providing guidance and feedback to business stakeholders.
• Perform impact assessments on upcoming standard changes, identifying necessary changes to the program, and work with the team and stakeholders to implement timely modifications to the system.
• Identify and communicate changes to the EDI 270/271 transactions to prepare end-users 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.
• Evaluate business processes and operations by implementing subject expertise, identifying problem areas, and providing relevant business solutions.
• Offer 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 270/271 transaction.
• Offer consulting services, contribute to specialized knowledge, and provide mentorship and training to teams.
• Verify business and technical information, including training manuals, user guides, and system requirements.
• Publicize important information and documents processes to stakeholders.
• Perform hands-on basic data query and exploratory analysis work and/or guide others in needed data analysis and interpret findings.

Requirements

Essential Qualifications

• Bachelor’s degree in Information Technology, Computer Science, or a 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 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 is highly preferable.
• Experience with fully redundant, high-volume (billions annually) applications is highly desirable.
• Experience working with agile teams.

Preferred Qualifications

• Experience with EDI 270/271 transactions and healthcare benefits policies.
• Knowledge of healthcare industry trends and regulations.
• Experience with data analysis and interpretation.
• Strong communication and interpersonal skills.

Clearance 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.

What We Offer

Compensation and Benefits

• Competitive salary.
• 65%-75% company-sponsored (including dependents) premiums towards medical, dental, and vision 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.

Work Environment and Culture

• 100% remote-first team environment.
• Flexible work hours.
• Opportunities for growth and professional development.
• Collaborative and agile team.
• Recognition and rewards for outstanding performance.

How to Apply

If you're a motivated and experienced Healthcare Provider Data SME looking for a new challenge, we encourage you to apply. Please submit your application, including your resume and a cover letter, to [[email protected]](mailto:[email protected]).

Don't hesitate to apply if you don't meet every single requirement. We value a great attitude and a willingness to learn above all. We look forward to hearing from you!

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