Healthcare EDI Analyst – Payer Connectivity

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

📋 Description

• Develop, sustain, and enhance connections with payers and trading partners to facilitate dependable electronic healthcare transactions.

• Investigate payer requirements, implement and verify connectivity solutions, maintain precise payer data, and address transaction issues within supported workflows.

• Serve as the subject matter expert and escalation point for issues related to payer connectivity, EDI, API, and web/screen capture.

• Collaborate with Product, Clearinghouse, Implementation, Engineering, Support, vendors, and trading partners to facilitate setup, troubleshooting, and optimization.

• Record payer lists, workflows, requirements, research findings, issue resolutions, and reference materials in designated systems.

• Validate and oversee new payer connections to ensure effective transaction exchanges.

• Examine reports, dashboards, Salesforce cases, and Jira tickets to identify trends, risks, and opportunities for improvement.

• Assist in process improvement, automation, and AI-driven projects aimed at enhancing monitoring, data accuracy, and workflow efficiency.

• Offer guidance and training on payer connectivity processes and best practices.

⛳️ Requirements

• Over 5 years of experience in business analysis, implementation, or client/payer-side roles, or in healthcare RCM software/technology.

• More than 3 years of involvement in healthcare eligibility and benefits within hospital and/or physician workflows.

• Comprehensive understanding of healthcare EDI transactions and workflows, including 270/271, 276/277, 278, 837, and 835.

• Familiarity with payer connectivity models, such as direct connections, clearinghouses, trading partners, AS2, SFTP, APIs, and FHIR-based integrations.

• Conduct research on payer requirements, interpret companion guides, and convert requirements into connectivity solutions.

• Proven experience in analyzing healthcare transaction data, diagnosing connectivity issues, verifying outcomes, and managing payer lists or transaction availability data.

• Proficient in Microsoft 365, Salesforce, Atlassian Jira, reporting tools, and dashboards.

• Experience with Experian Health platforms, similar healthcare technology solutions, Epic/Cerner, data analysis, automation, or AI-driven solutions.

🏝️ Benefits

• Attractive compensation package along with a bonus plan.

• Core benefits including medical, dental, vision, and a matching 401K.

• Flexible work environment with options to work remotely, in a hybrid model, or in-office.

• Flexible time off policy that includes volunteer time off, vacation, sick leave, and 12 paid holidays.