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Healthcare EDI Systems Analyst (Remote)

Conexess Group, LLC

Remote, IL(remote)

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JOB DETAILS
SKILLS
ActionScript, Alliance/Partner Management, Amazon Web Services (AWS), American National Standards Institute (ANSI), Analysis Skills, Application Programming Interface (API), Business-to-Business (B2B), Centers for Medicare and Medicaid Services (CMS), Cerner, Claims Processing, Cloud Computing, Communications Protocols, Computer Science, Data Analysis, Data Mapping, Data Quality, Documentation, Electronic Data Interchange (EDI), Epic Systems, Failure Analysis, Government, HIPAA (Health Insurance Portability and Accountability Act), HL7 (Health Level 7), HTTPS (HyperText Transport Protocol Secure), Health Informatics, Health Information Management, Healthcare, Healthcare Software, IBM Product Family, Identify Issues, Information Technology & Information Systems, JSON, Linux Administration, MEDITECH, Maintain Compliance, Medicaid, Medicare, Microsoft Windows Azure, Microsoft Windows System Administration, Operational Support, Operations Management, Operations Planning, Oracle, Performance Metrics, Problem Solving Skills, Production Support, Python Programming/Scripting Language, Reconciliation, Regulatory Compliance, Regulatory Requirements, Reimbursement, Reporting Dashboards, Reporting Skills, Requirements Management, Root Cause Analysis, SQL (Structured Query Language), Scripting (Scripting Languages), Secure/SSH File Transfer Protocol (SFTP), Security Auditing, Software Administration, Support Documentation, System Integration (SI), System Migration, Systems Administration/Management, Systems Analysis, Test Plan/Schedule, Time Management, Transaction Processing/Management, Unix Shell Programming, Web Services, Windows PowerShell, XML (EXtensible Markup Language)
LOCATION
Remote, IL(remote)
POSTED
4 days ago
Conexess Group is aiding a large healthcare client in their search for a Healthcare EDI Systems Analyst in a remote capacity. This is a long term contract opportunity with a competitive compensation package.
 
Please note we are unable to provide sponsorship or work c2c for this role.

The Healthcare EDI Systems Analyst is responsible for the implementation, support, monitoring, analysis, and optimization of Electronic Data Interchange (EDI) transactions across healthcare operations. This role ensures the accurate, secure, and HIPAA-compliant exchange of data between providers, payers, clearinghouses, government agencies, and third-party vendors.
Serving as the primary liaison between business stakeholders, healthcare operations, application support teams, and external trading partners, the analyst supports healthcare claims processing, revenue cycle operations, system integrations, and regulatory compliance.

Responsibilities
EDI Operations & Transaction Management
  • Monitor daily EDI transaction processing and error queues.
  • Troubleshoot and resolve issues with claims, eligibility, remittance, authorization, and enrollment transactions.
  • Ensure timely processing of inbound and outbound healthcare transactions.
  • Manage acknowledgments, reconciliations, and production support with minimal business disruption.
  • Coordinate issue resolution with providers, payers, clearinghouses, and vendors.
Healthcare Claims & Revenue Cycle Support
Support HIPAA X12 transaction workflows, including:
  • Claims: 837P, 837I, 837D
  • Eligibility: 270/271
  • Claim Status: 276/277
  • Prior Authorization: 278
  • Payments: 835 ERA and EFT reconciliation
  • Enrollment: 834
  • Acknowledgments: 999, 277CA, TA1
EDI Development & Integration
  • Translate business requirements into technical EDI solutions.
  • Design, develop, test, and implement EDI maps, workflows, and integrations.
  • Support integrations between EDI platforms and healthcare applications.
  • Configure communication protocols including AS2, SFTP, APIs, HTTPS, and secure web services.
  • Create mapping documentation and support system migrations and upgrades.
Healthcare Systems Support
Support and integrate healthcare applications including Epic, Cerner (Oracle Health), Meditech, Athenahealth, NextGen, eClinicalWorks, Allscripts/Veradigm, HealthEdge, Facets, QNXT, GuidingCare, and custom claims processing platforms.
Compliance & Trading Partner Management
  • Ensure compliance with HIPAA EDI standards and regulatory requirements.
  • Support CMS, Medicare, Medicaid, and commercial payer transactions.
  • Participate in audits, security reviews, and compliance documentation.
  • Onboard healthcare trading partners, coordinate connectivity and certification testing, maintain partner profiles, and serve as the escalation point for transaction issues.
Data Analysis & Reporting
  • Perform root cause analysis for transaction failures and claims processing issues.
  • Analyze data quality impacting reimbursement and member services.
  • Develop operational reports, dashboards, KPIs, and transaction performance metrics.
Qualifications
  • Bachelor's degree in Information Systems, Healthcare Informatics, Computer Science, Health Information Management, or related field (or equivalent experience).
  • 3+ years of healthcare EDI experience.
  • Experience supporting HIPAA X12 transactions, healthcare claims, eligibility, remittance, enrollment, and revenue cycle processes.
  • Experience working with providers, payers, clearinghouses, or healthcare technology organizations.
Technical Knowledge
Strong understanding of:
  • ANSI X12, HIPAA EDI, NCPDP, HL7, FHIR APIs, XML, and JSON.
  • Healthcare transactions including 834, 835, 837, 270/271, 276/277, 278, 999, and TA1.
  • One or more EDI platforms such as IBM Sterling B2B Integrator, Edifecs, Optum Intelligent EDI, OpenText, Cleo Integration Cloud, MuleSoft, Boomi, Cognizant TriZetto, HealthEC, or Oracle Integration Cloud.
Technical Competencies
  • SQL and data analysis
  • Healthcare data mapping and EDI troubleshooting
  • API integrations and data validation
  • Healthcare claims processing systems
  • Windows/Linux administration
  • Scripting (PowerShell, Python, or Shell)
Preferred
  • CPHIMS or Healthcare Informatics certification.
  • Experience with healthcare clearinghouses.
  • Medicare/Medicaid knowledge.
  • HL7/FHIR integrations.
  • Cloud integration platforms (Azure, AWS, or Google Cloud).
  • Knowledge of value-based care and population health data exchanges.
 
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About the Company

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Conexess Group, LLC