EDI Technical Analyst

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Analyze, configure, implement, and provide support for healthcare EDI transactions.

• Oversee daily EDI processing and address transaction failures, rejections, and data integrity concerns.

• Perform root cause analysis and suggest corrective measures for production challenges.

• Collaborate with business and operational teams to determine EDI needs and system enhancements.

• Evaluate inbound and outbound EDI files and transaction sets to ensure HIPAA compliance.

• Create and maintain mapping specifications, technical documentation, and data flow diagrams.

• Conduct impact assessments for system upgrades, regulatory modifications, and business initiatives.

• Facilitate integration between payer core administration systems and external trading partners.

• Organize and carry out unit, system, integration, and user acceptance testing.

• Develop test plans, test cases, and validation processes.

• Assist in onboarding providers, clearinghouses, employer groups, and vendor trading partners.

• Verify the accuracy of EDI transactions during implementations and system upgrades.

• Ensure adherence to HIPAA X12 standards and CMS regulations.

• Stay updated on industry developments influencing EDI transactions and healthcare interoperability.

• Support audit requests and regulatory reporting tasks.

• Collaborate with business analysts, developers, operations teams, providers, clearinghouses, and external vendors.

• Act as a subject matter expert for EDI processes and troubleshooting transactions.

• Provide production support and engage in issue resolution meetings.

⛳️ Requirements

• Bachelor's degree in Information Systems, Healthcare Administration, Computer Science, or equivalent professional experience.

• A minimum of 3 years of experience in healthcare EDI within a payer organization.

• Comprehensive knowledge of HIPAA X12 transaction sets (834, 837, 835, 270/271, 276/277, 278, 820).

• Experience with healthcare claims, enrollment, eligibility, provider, and payment processes.

• Skilled in analyzing EDI files and resolving transaction errors.

• Familiarity with SQL and database querying.

• Understanding of healthcare payer operations and managed care principles.

• Strong analytical, problem-solving, and communication abilities.

• Experience with payer platforms such as Facets, QNXT, or HealthRules Payor.

• Proficient in EDI tools such as IBM Sterling, Edifecs, BizTalk, or Cleo.

• Knowledge of XML, JSON, APIs, and healthcare interoperability standards.

• Experience supporting Medicare, Medicaid, and Commercial lines of business.

• Familiarity with Agile methodologies and project management practices.

🏝️ Benefits

• Multiple health and dental plans with nationally recognized networks.

• Vision benefits.

• Comprehensive wellness program.

• Employee assistance program available for employees and their families.

• Competitive salary.

• Retirement savings plans.

• Company-paid disability and life insurance.

• Pre-tax savings options (HSA and/or FSA).

• Opportunities for professional development.

• Options for remote work.

• Generous paid time off policy.

• Flexible scheduling to accommodate vacations, illness, life events, and unforeseen circumstances.