Our client is seeking an Analyst, Systems (Senior) to provide Electronic Data Interchange (EDI) data analysis and support services for the client Health Benefit Exchange (HBX) system.
Duties and Responsibilities:
- Work for the EDI Operations team to provide EDI related services for the Exchange.
- Perform 8001 Flat File validation and analysis; review multiple MPIs for SSN matching.
- Perform HBX System Error analysis.
- Validate 1095-A and 1095-B files, reconcile 8001 transactions.
- Analyze EDI files sent to and received from Carriers/Managed Care Organizations (MCO) and identify errors and root cause for EDI file rejections.
- Coordinate with the development team, business operations team and the testing team to analyze, fix, test and transmit EDI files on a daily basis.
- Analyze the EDI 999 files from the Carriers and MCOs and perform root cause analysis for exceptions.
- Perform data changes to fix consumer or system reported errors, coordinate with technical and business teams to analyze error reports, access HBX database and application to perform root cause analysis for transaction rejections.
- Communicate with the IT team, business team, vendor team and other stakeholders to translate business needs into EDI data fixes and solutions.
- A minimum of four (4) years of experience with Health Exchange EDI solutions.
- A minimum of four (4) years of experience in creating EDI X12 files for transactions sets such as 834, 999 and TA1.
- A minimum of four (4) years of experience in reviewing and understanding technical documents such as companion and implementation guides for Healthcare EDI formats 834 and 999.
- A minimum of four (4) years of experience in analyzing/testing Healthcare/Marketplace EDI Applications.
- A minimum of two (2) years of experience working with SQL databases/queries.
- Strong analytical and problem solving skills.
- Excellent communication skills including the ability to understand and communicate technical information to business users, and gather business requirements that can be translated into technical requirements.
- Ability to manage multiple critical priorities and tight deadlines.
Bachelor’s Degree from an accredited college or university in Engineering, Computer Science, Information Systems, Business or other related Discipline. Master’s degree preferred.
- Six (6) years of experience with EDI validation tools such as Edifecs, WTX, EDI X12 files.
- Six (6) years of experience with transactions sets such as 834, 999 and TA1, SOA, EDI and EAI Applications.
- Strong knowledge in the Affordable Care Act (ACA) eligibility rules.
- Experience with or knowledge of 8001/IDB file processing.
- Knowledge of Medicaid coverage types, coverage span and eligibility rules.
- In-depth understanding of 834 enrollment transactions including Adds, Terminations, Cancellations and Life events.
- Strong knowledge of database and SQL scripts.