Senior Healthcare EDI X12 Business Systems Analyst/Healthcare EDI X12 PM
United States
Full-time
2 hours ago
H1B Sponsor Likely
Key skills
Healthcare EDI (X12N)HIPAA/EDI X12 5010Edifecs platformSQLEDI troubleshootingProject ManagementStakeholder ManagementAgile methodologyWaterfall methodologyIntegration patternsAgileLeadership
About this role
Infinite Computer Solutions is a global leader in digital engineering and IT services, seeking a Senior Healthcare EDI X12 Business Systems Analyst/Healthcare EDI X12 PM. The role involves managing EDI implementation projects, ensuring compliance with HIPAA standards, and acting as a liaison between internal teams and external partners.
Responsibilities:
- Project Delivery: End-to-end management of EDI implementation, upgrades, and migration projects (e.g., to cloud, Sterling B2B Integrator)
- Stakeholder Management: Acting as the primary liaison between internal business teams, IT, and external trading partners
- Technical Oversight: Overseeing mapping, testing, and transaction flows (ANSI X12, EDIFACT, XML, JSON) and ensuring data security
- Methodology & Governance: Utilizing Agile or Waterfall to define project plans, milestones, and risk mitigation strategies
- Documentation & Reporting: Maintaining mapping specifications and providing regular status updates to leadership
Requirements:
- Extensive hands-on experience with Healthcare EDI (X12N) standards, including deep understanding of transaction structures, segment loops, code sets, and compliance rules that govern HIPAA-mandated EDI exchanges
- In-depth knowledge of HIPAA/EDI X12 5010 transactions, including but not limited to: 270/271, 276/277, 277CA, 820, 834, 835, 837 (I/P/D), and 999
- Proven ability to interpret, validate, and troubleshoot EDI files end-to-end — including envelope structures, ISA/GS segments, ST/SE loops, and companion guide variations
- Expert-level understanding of EDI concepts, practices, and workflows within the healthcare ecosystem (enrollment, eligibility, claims, remittance, prior authorization, premium billing, etc.)
- Hands-on troubleshooting experience with EDI file processing flows, including identifying translation errors, mapping issues, partner-specific formatting discrepancies, and system integration failures
- Experience with the Edifecs platform, including: SpecBuilder (creating and maintaining implementation guides), Edifecs Mapper (map development and debugging), XEngine / XEServer (validation, translation, and processing rules), TPM (trading partner configuration)
- Ability to debug processing logs, analyze error codes, and tune validation rules
- Proficiency in SQL for data validation, root-cause analysis, and troubleshooting upstream/downstream system issues
- Single point of accountability for up to 20 direct and/or matrixed staff, including sub-contractor(s)
- PMP Certified
- Project Manager with x years of experience
- EDI specific domain - Strong knowledge in EDI environment, upstream and downstream
- Resource should have 12+ Years of experience
- Exposure with QNXT preferred, including understanding of core modules such as claims, enrollment, provider, and benefits configuration
- CEF/QNXT EDI Gateway experience would be preferrable