Senior Systems Analyst (EDI)

ANGARAI•College Park, MD

13d

About The Position

The Senior Systems Analyst (EDI) is responsible for providing Electronic Data Interchange (EDI) data analysis, transaction support, error resolution, and related services for large-scale healthcare or eligibility-based systems. This role works closely with technical, business, and testing teams to analyze, resolve, and transmit EDI transactions accurately and efficiently.

Requirements

Bachelor’s degree in Computer Science, Information Systems, Engineering, Business, or a related field
Minimum 4 years of experience working with healthcare marketplace or eligibility-based EDI solutions
Minimum 4 years of experience creating and processing EDI X12 transaction sets such as 834, 999, and TA1
Minimum 4 years of experience reviewing and interpreting EDI companion guides and implementation guides
Minimum 4 years of experience analyzing, testing, and providing data solutions for healthcare or eligibility systems
Minimum 2 years of experience working with SQL databases and writing SQL queries
Strong analytical and problem-solving skills
Excellent communication skills with the ability to translate technical concepts for business users
Ability to manage multiple priorities and meet tight deadlines

Nice To Haves

6+ years of experience using EDI validation tools such as Edifecs, WTX, or equivalent
6+ years of experience working with EDI transaction sets including 834, 820, 999, and TA1
Hands-on experience writing complex SQL scripts
Knowledge of Affordable Care Act (ACA) eligibility rules for Medicaid and Qualified Health Plans
Experience with or knowledge of 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 ongoing support for EDI operations
Perform analysis and validation of Medicaid 8001 transaction files
Review and resolve data issues related to master data, master person identifiers, and other system data discrepancies
Perform system error analysis and root cause investigation
Validate 1095-A and 1095-B files and reconcile 8001 transactions
Analyze inbound and outbound EDI files exchanged with carriers, managed care organizations, and external partners
Identify EDI file rejections, analyze root causes, and recommend corrective actions
Analyze EDI 999 acknowledgment files and assist with resolving exceptions and data issues
Coordinate with development, business, and testing teams to analyze, fix, test, and transmit EDI files on a daily or as-needed basis
Perform data corrections to resolve consumer- or system-reported issues
Access databases and applications to perform root cause analysis and implement data fixes
Translate business needs into technical EDI data solutions
Communicate effectively with IT teams, business users, vendors, and stakeholders
Support flexible work schedules, including off-hours, weekends, and holidays as required