EDI Healthcare Analyst

Seeking experienced EDI Healthcare Analysts with expertise in encounter data processing, EDI submission, reconciliation testing, member enrollment workflows, and healthcare payer domain knowledge, including familiarity with Edifecs and X12 EDI standards.

Location: United States

Salary: $40/hr

Responsibilities

• Encounter data processing, EDI submission, and reconciliation testing for a healthcare payer.
• Member enrollment workflows.

Requirements

• Experience in encounter data processing, EDI submission, and reconciliation testing for a healthcare payer.
• X12 EDI knowledge: 837P, 837I, 837D (Professional, Institutional, Dental).
• Facets claims module familiarity and validation.
• SQL for encounter data validation and member data comparisons.
• TOSCA or Robot Framework test automation.
• Healthcare payer domain knowledge including CMS encounter submission rules and state-specific guides.
• Facets membership/enrollment module testing and data flow validation.
• Full transaction expertise with X12 EDI 834 (Benefit Enrollment & Maintenance).
• Experience with member add/change/term, dependent handling, dual-enrollment scenarios.
• Knowledge of retroactive adjustments and deeming logic (Medicaid/MMP/Dual).
• 820 (Premium Payment) validation linkage.
• Member eligibility cross-validation (270/271).
• Enrollment reconciliation between source systems and downstream systems.
• Experience with automation tools like TOSCA.
• LOB knowledge: Medicaid, Medicare Advantage, Duals/MMP, TRICARE, Marketplace.

Benefits

• W2 employment.
• Hourly rate of $40.