Systems Analyst; EDI

Overview

The Senior Systems Analyst supports Electronic Data Interchange (EDI) operations for a Health Exchange, providing advanced data analysis, error resolution, and transactional support. This role works closely with technical and business teams to ensure accurate and timely processing of healthcare enrollment and Medicaid transactions.

Baltimore

2 years

• Analyze and validate Medicaid 8001 transaction files.
• Review and resolve data issues related to MDM, MPI, and HBX systems.
• Validate and reconcile 1095-A and 1095-B files.
• Analyze inbound and outbound EDI X12 files (834, 999, TA1) from Carriers and MCOs to identify errors and root causes.
• Review EDI 999 responses and coordinate issue resolution.
• Perform data corrections and support transaction reprocessing.
• Collaborate with development, testing, business, vendor, and IT teams to analyze, test, and deploy EDI fixes.
• Translate business requirements into technical EDI solutions.

• 8 plus year of general experience
• 4+ years of experience with Health Exchange EDI solutions.
• 4+ years of experience working with EDI X12 (834, 999, TA1).
• 4+ years reviewing EDI implementation and companion guides.
• 2+ years of SQL experience.
• Strong analytical, troubleshooting, and communication skills.
• Ability to manage multiple priorities in a deadline-driven environment.

• 6+ years using EDI tools (Edifecs, WTX, or equivalent).
• Experience with Medicaid 8001 processing.
• Knowledge of ACA eligibility rules and healthcare enrollment workflows.
• Advanced understanding of 834 enrollment transactions and error handling.

Overtime, including weekends and holidays, may be required.