Senior EDI Analyst

We are seeking an experienced Senior EDI Analyst to support and enhance a healthcare claims processing platform responsible for managing the complete lifecycle of electronic healthcare claims. This role will serve as a subject matter expert (SME) for EDI transactions, claims adjudication processes, provider onboarding, and healthcare data exchanges.

The ideal candidate will possess strong expertise in HIPAA-compliant EDI transactions, healthcare claims processing, database technologies, and troubleshooting complex integration issues. This position will collaborate closely with project managers, software developers, business analysts, and business stakeholders to support modernization initiatives and ongoing operational excellence.

Key Responsibilities

EDI & Claims Processing

Manage and support the end-to-end lifecycle of healthcare claims transactions.

Monitor, validate, and troubleshoot incoming and outgoing EDI transactions.

Ensure successful processing of healthcare claims and adjudication responses.

Maintain accurate and reliable data exchanges with providers, clearinghouses, and external trading partners.

Resolve EDI transmission errors, claim rejections, and data integrity issues.

Documentation & Process Improvement

Review, update, and maintain claims processing and EDI-related documentation.

Identify undocumented workflows and create comprehensive process documentation.

Recommend process improvements to enhance operational efficiency and system reliability.

Business & Technical Analysis

Serve as the EDI and claims processing Subject Matter Expert (SME).

Collaborate with technical and business teams to gather and analyze requirements.

Translate business requirements into detailed technical specifications.

Support system modernization and application enhancement initiatives.

Testing & Quality Assurance

Participate in testing of new system functionality and enhancements.

Validate EDI transaction processing and claims adjudication results.

Support defect identification, troubleshooting, and resolution activities.

Provider & Trading Partner Support

Provide support for healthcare providers utilizing the claims processing platform.

Assist with onboarding new healthcare providers and clearinghouses.

Respond to EDI-related inquiries and support requests.

Work closely with internal and external stakeholders to resolve operational issues.

Do you have experience in X12 EDI?, Do you have a Bachelor’s degree?, Bachelor’s Degree in Computer Science, Information Technology, Healthcare Informatics, or a related field.

5+ years of experience working with healthcare EDI transactions and claims processing systems.

Strong understanding of EDI transaction sets including:

837 Healthcare Claim

835 Claim Payment/Remittance Advice

270/271 Eligibility Transactions (preferred)

Knowledge of HIPAA regulations and healthcare data exchange standards.

Strong database and data analysis experience.

Excellent troubleshooting and problem-solving skills.

Strong verbal and written communication skills.

Ability to work independently with minimal supervision.

Experience collaborating with cross-functional technical and business teams.

Preferred Qualifications

Healthcare industry experience.

Experience with claims adjudication systems.

Strong SQL and database development experience.

Experience with IBM WebSphere Transformation Extender (WTX).

Experience supporting provider and clearinghouse integrations.

Familiarity with healthcare reimbursement and pricing methodologies.

Technical Skills

EDI Transactions: 835, 837, HIPAA Standards

Claims Processing & Adjudication

SQL & Database Technologies

Data Mapping & Integration

Requirements Analysis

System Testing & Validation

Provider Onboarding

Trading Partner Management

Issue Resolution & Production Support

Pay: Up to $59.06 per hour, Describe your experience working with healthcare EDI transactions (such as 835 and 837). What types of transactions did you support, and what were your primary responsibilities? * Describe your experience working with databases and SQL in support of EDI or healthcare claims systems. Include examples of queries, troubleshooting, reporting, or data validation activities you performed.

• What healthcare systems, EDI mapping tools, clearinghouses, or integration platforms have you worked with, and how did you use them in your day-to-day responsibilities?

* Currently, the client is not willing to sponsor visas at this time. Are you able to work independently without sponsorship? GC or USC are preferred * Tell us about a project where you collaborated with business users, developers, and external trading partners or providers. What was your role, and what was the outcome of the project?

Education:

• Bachelor’s (Required)

Experience:

• Database Knowledge: 5 years (Required)
• Understanding EDI file formats (835, 837, 210): 5 years (Required)

Up to $59.06 an hour - Full-time, Contract