About this role

Analyze and troubleshoot complex ANSI X12 5010 835 (ERA) transactions, identifying processing, formatting, balancing, and compliance issues
Perform root cause analysis, resolve EDI processing issues, and implement preventive solutions
Design and maintain EDI integration workflows, data mappings, technical documentation, and testing plans
Interpret payer and provider specifications to ensure compliance with HIPAA, ANSI X12, and trading partner requirements
Generate, validate, and review EDI files, communicating findings and recommendations to internal teams and clients
Serve as the technical point of contact for escalated 835 remittance, provider payment, and clearinghouse issues
Partner with internal teams, clients, vendors, and trading partners to resolve integration, connectivity, and workflow challenges
Leverage AI-enabled tools and automation to improve data quality, validation, reconciliation, and operational efficiency
Manage multiple priorities, document best practices, ensure HIPAA compliance, and identify process improvement opportunities
Mentor junior analysts and stay current with healthcare EDI standards, integration technologies, and AI advancements

Bachelor's degree in Information Systems, Healthcare Administration, Computer Science, or a related field, or equivalent experience
5–7+ years of healthcare EDI experience, including 3–5+ years supporting HIPAA ANSI X12 835 transactions; experience with 837, 834, and 270/271 is a plus
Strong understanding of the healthcare claims lifecycle, payment processing, provider payment posting, and reconciliation
Experience with EDI validation tools (Edifecs, Crystal Validation), ANSI X12 standards, data mapping, and healthcare integration processes
Advanced SQL and data analysis skills; Microsoft SQL Server experience preferred
Proficiency with Microsoft Teams, Word, Excel, Notepad++, and AI tools such as ChatGPT; Jira, C#, or API experience is a plus
Excellent analytical, communication, troubleshooting, and problem-solving skills, with the ability to mentor junior analysts and collaborate across technical, operational, and client-facing teams

401k plan with employer match
flexible paid time off
holidays
parental leaves
life and disability insurance
health benefits including medical, dental, vision, and prescription drug coverage

EDI Analyst

Key skills