EDI Solutions Architect - Medicaid Programs

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities.

Working at Gainwell carries its rewards. Youll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development.

Youll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance.

We also have comprehensive leadership and technical development academies to help build your skills and capabilities.

Summary

As an EDI Solutions Architect - Medicaid Programs at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve a communitys most vulnerable.

Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcares biggest challenges.

Your role in our mission

• Product Owner and primary point of contact for the designated product.
• Collaborate with diverse teams for timely delivery of product changes and enhancements.
• Single owner aligning ADO workload with PMO / Scrum Master to meet delivery timelines.
• Define and manage architectural roadmaps for platforms, products, or services.
• Provide expertise in the interaction of business and technical capabilities to address client goals.
• Direct project and program design activities, ensuring alignment with customer and company objectives.
• Conduct customer process analysis, recommend technical improvements, and evaluate existing processes.
• Enable parallel work of cross-functional teams through guidance in business solution architecture.
• Support, resolve, and document issues in the architecture, reviewing and recommending improvements.
• Ensure recommended business solutions meet customer's price, scope, and time requirements.
• Utilize professional concepts for resolution of critical issues and broad design matters.
• Stay informed of industry trends, best practices, and standards, introducing new technology processes.
• Provide leadership and guidance to less experienced personnel.
• Possess knowledge of Medicaid program regulations, compliance requirements, and specific policies
• In-depth understanding of Medicaid Management Information Systems (MMIS) architecture and EDI principles.

What we're looking for

5+ years Hands-on experience with EDI software, including tools like EDI translators, EDI gateways, and familiarity with secure file transfer protocols (SFTP, FTPS, AS2).

EDI Process Expertise : In-depth understanding of the EDI process, covering aspects such as data formats, data mapping, data transformation, and data validation.

Medicaid EDI Standards : Proficient in Medicaid-specific EDI standards and transactions, such as X12 (including 837, 835, 834, 270 / 271, 275, 276 / 277, 278), NCPDP, or other relevant Medicaid EDI standards.

Healthcare Data Privacy Knowledge : Knowledgeable about healthcare data privacy and security best practices, including encryption, access controls, audit trails, and data masking.

Healthcare EDI Transaction Experience : Practical experience with EDI transactions commonly used in healthcare, such as claims processing, eligibility verification, remittance advice, and prior authorization.

Database Systems Familiarity : Familiarity with database systems, understanding data modeling principles, proficiency in writing SQL queries, and awareness of data integration platforms commonly used in Medicaid Management Information Systems (MMIS) environments.

What you should expect in this role

• Opportunities to travel through your work (0-10%)
• Fully remote opportunity with the option to work anywhere within the United States
• Ideal Candidate : The ideal candidate is an experienced EDI Solutions Architect with hands-on expertise in Medicaid-specific standards, showcasing a deep understanding of the EDI process and practical experience in healthcare transactions.

Their proficiency includes leading product enhancements and contributing innovative solutions to the dynamic landscape of Medicaid Programs."

• NOTE : Video cameras must be used during all interviews, as well as during the initial week of orientation.
• This posting is intended for pipelining. We will accept applications on an ongoing basis

Put your passion to work at Gainwell. Youll have the opportunity to grow your career in a company that values work flexibility, learning, and career development.

All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a , and educational assistance.

We also have a variety of leadership and technical development academies to help build your skills and capabilities.