Healthcare EDI Analyst

ASSYST•Baltimore, MD

21h

About The Position

ASSYST is seeking an experienced Healthcare EDI Analyst for supporting the Electronic Data Interchange (EDI) operations of our client by performing detailed data analysis, transaction validation, error detection and resolution. This role involves working extensively with healthcare EDI X12 transactions, Medicaid and ACA marketplace files and collaborating with technical and business teams to ensure accurate, timely and compliant data exchanges with external partners.

Requirements

Experience supporting Health Exchange marketplace EDI solutions.
Experience creating EDI X12 files, including transaction sets 834, 999 and TA1.
Experience reviewing and interpreting technical documentation such as EDI companion guides and implementation guides for healthcare EDI formats (834 and 999).
Experience analyzing, testing and delivering data solutions for healthcare marketplaces.
Experience working with SQL databases and queries.
Strong analytical and problem-solving skills.
Excellent communication skills, with the ability to explain technical concepts to business users and translate business requirements into technical solutions.
Ability to manage multiple critical priorities and work effectively under tight deadlines.

Nice To Haves

Experience using EDI validation tools such as Edifecs, WTX, or equivalent.
Experience working with EDI transaction sets including 834, 820, 999 and TA1, as well as SOA, EDI, or EAI applications.
Hands-on experience writing complex SQL scripts.
Knowledge of Affordable Care Act (ACA) eligibility rules for Medicaid and Qualified Health Plans.
Experience with Medicaid 8001 file processing or other inter-agency transactional file processing.
In-depth understanding of EDI 834 enrollment transactions, including adds, changes, terminations, cancellations and error processing.

Responsibilities

Provide data analysis, transactional support, error detection, resolution and related services to ensure successful Electronic Data Interchange (EDI) operations for the client.
Perform analysis and validation of Medicaid 8001 transaction files and reconcile associated enrollment and eligibility data.
Review, analyze and resolve data issues related to Master Data Management (MDM), Master Person Identifier (MPI) and other data integrity concerns.
Conduct HBX system error analysis to identify and resolve transaction failures.
Validate 1095-A and 1095-B files and reconcile 8001 transactions to ensure data accuracy and regulatory compliance.
Analyze inbound and outbound EDI files exchanged with Carriers, Managed Care Organizations (MCOs) and other external entities; identify errors and determine root causes for EDI file rejections.
Coordinate with development, business and testing teams to analyze, resolve, test and transmit EDI files on a daily basis and as required.
Analyze EDI 999 acknowledgement files from Carriers and MCOs, perform root cause analysis for exceptions and assist in resolving data-related issues.
Perform data updates to correct consumer- or system-reported errors and work with technical and business teams to analyze error reports.
Access HBX databases and applications to perform root cause analysis for transaction rejections and implement data fixes and technical solutions.
Communicate with IT teams, business stakeholders, vendor teams and external partners to translate business requirements into effective EDI data fixes and solutions.