X12 Developer Role OverviewThis role is responsible for designing, supporting, and maintaining a large scale healthcare billing and eligibility platform that processes Medicaid and commercial insurance transactions across multiple states. The developer will own end-to-end billing workflows—including eligibility, claim submission, remittance processing, escrow and recoupment logic, and corrections—ensuring claims are accurate, compliant, and paid correctly. The developer will work heavily in backend integration services, SQL Server stored procedures, and batch processing systems, troubleshooting complex production issues, implementing payer- and state-specific business rules, and performing data corrections when needed.
This role requires close collaboration with billing operations, data teams, and compliance stakeholders to translate policy and reimbursement rules into reliable system behavior. Success in this role means keeping mission critical billing processes running, resolving production issues quickly and safely, preventing duplicate or incorrect claims, and continuously improving the stability, performance, and correctness of a business critical system.Key Responsibilities & Required SkillsDeep experience with HIPAA X12 transactions: 270/271 (Eligibility), 276/277 (Claim Status), 837P/I (Claims), 835 (Remittance), 999/TA1 acknowledgementsStrong understanding of Medicaid and commercial insurance billing workflows, including Primary vs secondary claims, Escrow and recoupment logic, voids, corrections, rebills, sweeps, denials, and adjustmentsUnderstanding of Healthcare revenue & claims life cycle including, escrow, takebacks, overpayments, rate corrections, voids, corrections, rebills, sweeps, and reprocessingAbility to debug payer specific rules and state specific Medicaid behaviorsAdvanced SQL Server skills including writing, debugging, and optimizing complex stored procedures, diagnosing stuck records, data corrections, backfills, and one time cleanup scripts in productionExperience maintaining batch oriented and transaction oriented processing systemsDesign and support SFTP based inbound/outbound integrations for large flat files (837/835, eligibility feeds, daily ETLs)Build and maintain high volume, batch oriented, file based processing workflowsImplement resilient import pipelines with error handling, retry logic, alerting, and recovery mechanismsExperience operating production systems in AWSComfort working in mixed legacy + modern environmentsProven ability to: Triage production issues quickly using logs, data analysis, and job historyIdentify root causes across application code, stored procedures, and dataExecute fixes under production pressureExperience responding to recurring system alerts and eliminating root causesDiagnosing job timing, retries, late files, partial runsImplement and maintain complex validation/edit logicTranslate policy changes into code and data changesStrong attention to reporting, financial accuracy and audit readinessDesign and support configurable solutions to accommodate varying state rulesComfortable working with domain experts (billing, compliance, operations)Writes clear, auditable SQL and application logicDocuments decisions and understands regulatory impactRequired Technical SkillsC# development with.NET Core 6/8/10,.NET Framework 4.8, and ASP.NET Web FormsEDI/X12 processing using EdiFabric or equivalent EDI toolkitsX12 transaction pipelines (837, 835, eligibility, acknowledgments)Secure application development including PII/PHI handling (HIPAA) and role based accessConfiguration driven architecture separating code from environment, client, and state/agency rulesSQL Server 2019+Advanced TSQL (complex queries, data modification, performance optimization)SSIS package maintenance and tuningStored procedures, views, and database securityData analysis across highly configurable schemasDatabase deployment and release scriptingEntity FrameworkLINQ query compositionDbContext lifecycle and performance managementDebugging and root cause analysisAbility to identify, refactor, and improve poorly performing codeApplication and database performance tuningCode refactoring for maintainability and scalabilityUnit testing for new and existing functionalityGit (branching strategies, pull requests, code reviews)Azure DevOps (pipelines, work items, repositories)Environment aware development and deployment patternsFile based and database driven configuration managementKavaliro provides Equal Employment Opportunities to all employees and applicants. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
Kavaliro is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Kavaliro will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please respond to this posting to connect with a company representative.