EDI Integration Specialist - Clover Solutions LLC

Role: EDI Integration Specialist (Not Developer)

Location : Remote

Duration : Contract

Experience : 12+ years

External facing experience is MUST

We are seeking a skilled Integration Specialist with strong Electronic Data Interchange

(EDI) expertise and a solid understanding of healthcare domain standards to design, develop,

and maintain integration solutions. This role will focus on implementing, testing, and supporting

EDI transactions, ensuring compliance with HIPAA and healthcare industry standards.

Key Responsibilities

Design, develop, and maintain integration solutions for healthcare data exchange using

EDI standards (e.g., X12, HL7).

Implement, configure, and support EDI transactions such as 837 (claims), 835

(remittance), 270/271 (eligibility), 276/277 (claim status).

Work with healthcare partners, payers, and providers to troubleshoot and resolve

integration issues.

Develop mapping, translation, and transformation processes between internal systems

and external partners.

Ensure compliance with HIPAA, security protocols, and industry data exchange

requirements.

Collaborate with business analysts, QA teams, and project managers to gather

requirements and deliver high-quality integration solutions.

Monitor integration processes and proactively identify performance or data issues.

Maintain detailed technical documentation and provide training or knowledge transfer to

internal teams.

Required Skills & Qualifications

Bachelor s degree in Computer Science, Information Technology, or related field (or

equivalent experience).

5+ years of experience in integration development, with a strong focus on EDI in the

healthcare industry.

Proficiency in healthcare EDI standards (HIPAA X12, HL7).

Hands-on experience with integration tools (e.g., MuleSoft, Dell Boomi, Cloverleaf, IBM

Sterling Integrator, BizTalk, or similar).

Strong knowledge of healthcare processes including claims, eligibility, payments, and

prior authorizations.

Solid understanding of XML, JSON, SQL, REST, and SOAP-based web services.

Strong troubleshooting and problem-solving skills.

Excellent communication and collaboration abilities.

Preferred Qualifications

Experience with cloud-based integration platforms (e.g., Azure Logic Apps, AWS Step

Functions, or Google Cloud Platform integrations).

Knowledge of FHIR (Fast Healthcare Interoperability Resources) standards.

Previous work with payer or provider systems.

Familiarity with agile development methodologies.

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