EDI Analyst, Eligibility
About The Position
Analyze, design, and improve electronic data interchange (EDI) processes related to the timely and accurate processing of 837 X12 Encounter files and other healthcare claims system transactions. Perform business and systems analysis to support enrollment data file operations, ensuring data integrity, compliance with industry standards, and process efficiency. Monitor, troubleshoot, and resolve errors in production file processing, conduct root cause analysis and implement corrective actions to prevent future issues. Validate 834 enrollment files using industry-standard HIPAA compliance rules via IBM ITXA and in-house custom validation processes. Interpret and analyze response files, including 999, 277, and 835, to assess processing accuracy and ensure compliance with state and client requirements. Conduct SQL-based data analysis to identify trends, correlations, and anomalies in claims, member, and provider data, optimizing data processing workflows. Develop and generate SQL-based reports for data-driven decision-making, producing scheduled and ad-hoc reports for clients and internal stakeholders. Collaborate with internal teams and external clients to support new client implementations, system modifications, and process improvements. Design, document, and execute test plans for EDI processes, ensuring accurate data exchange and system functionality. Provide technical support and respond to client inquiries regarding EDI transactions, data integrity, and system performance. Maintain and configure core EDI systems, integrating changes requested by clients and internal operational departments. Automate routine processes with monitoring controls to enhance operational efficiency and reduce manual intervention. Document system configurations, workflows, and troubleshooting procedures to ensure knowledge transfer and process consistency.
Requirements
- Master’s degree in Computer Science, Software Engineering, or related technical field or foreign degree equivalent.
- Demonstrated ability with SQL for data analysis, troubleshooting, and creating recurring and ad-hoc reports
- Demonstrated ability with root cause analysis and implementing corrective actions to prevent future issues
- Demonstrated ability coordinating with clients and internal teams, manage updates, and participate in status calls and implementations
- Demonstrated ability with designing and executing test plans and maintaining comprehensive documentation for processes and procedures.
- Aforementioned ability may be gained professionally or academically (coursework, projects, internships).
Responsibilities
- Analyze, design, and improve electronic data interchange (EDI) processes related to the timely and accurate processing of 837 X12 Encounter files and other healthcare claims system transactions.
- Perform business and systems analysis to support enrollment data file operations, ensuring data integrity, compliance with industry standards, and process efficiency.
- Monitor, troubleshoot, and resolve errors in production file processing, conduct root cause analysis and implement corrective actions to prevent future issues.
- Validate 834 enrollment files using industry-standard HIPAA compliance rules via IBM ITXA and in-house custom validation processes.
- Interpret and analyze response files, including 999, 277, and 835, to assess processing accuracy and ensure compliance with state and client requirements.
- Conduct SQL-based data analysis to identify trends, correlations, and anomalies in claims, member, and provider data, optimizing data processing workflows.
- Develop and generate SQL-based reports for data-driven decision-making, producing scheduled and ad-hoc reports for clients and internal stakeholders.
- Collaborate with internal teams and external clients to support new client implementations, system modifications, and process improvements.
- Design, document, and execute test plans for EDI processes, ensuring accurate data exchange and system functionality.
- Provide technical support and respond to client inquiries regarding EDI transactions, data integrity, and system performance.
- Maintain and configure core EDI systems, integrating changes requested by clients and internal operational departments.
- Automate routine processes with monitoring controls to enhance operational efficiency and reduce manual intervention.
- Document system configurations, workflows, and troubleshooting procedures to ensure knowledge transfer and process consistency.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
