<p>Kforce has a client in Montebello, CA that is in need of a Healthcare 837 EDI Specialist.</p> <p>Responsibilities:</p> <ul> <li>Interpret ASC X12 837 files (837P and 837I), identifying loops and segments </li><li>The Healthcare 837 EDI Specialist will manage EDI claims submission, exchange, and reconciliation </li><li>Process related files: 837D, 277CA, 999, and TA1 </li><li>Respond to EDI acknowledgments and error reports, identifying accepted vs. rejected claims </li><li>Write and modify intermediate-level SQL queries for data extraction, updates, and reporting </li><li>Perform update statements, joins, and CASE logic </li><li>Maintain and update SQL scripts based on requirements </li><li>Analyze and troubleshoot healthcare claims data using SQL </li><li>Python scripting for automating EDI tasks is a plus </li><li>The Healthcare 837 EDI Specialist will map claim form fields to EDI segments </li><li>Understand healthcare claims workflows and EDI clearinghouses* Bachelor's degree or equivalent experience required </li><li>4+ years in managed health care, preferably with a Health Plan or Managed Services Organization </li><li>2+ years with ASC X12 837 files (837P, 837I, 837D, 277CA, 999, TA1) </li><li>2+ years generating and submitting healthcare EDI files, with SQL knowledge </li><li>Knowledge of ICD-10, CPT, HCPCS, NDC coding, and EDI Clearinghouses </li><li>Familiarity with Medicare, Medicaid, and Commercial healthcare lines is a plus </li><li>Skilled in reading and interpreting raw EDI files </li><li>Intermediate SQL skills for joins, updates, and complex queries </li><li>Advanced Excel skills: pivot tables, sorting, filtering, VLOOKUP/XLOOKUP, formulas </li><li>Proficient with Microsoft Office tools, especially Outlook and Word </li><li>Exposure to Python or SSIS is a plus </li></ul>