Senior Systems Analyst; EDI

The Senior Systems Analyst (EDI) is responsible for providing Electronic Data Interchange (EDI) data analysis, transaction support, error resolution, and related services for large-scale healthcare or eligibility-based systems. This role works closely with technical, business, and testing teams to analyze, resolve, and transmit EDI transactions accurately and efficiently.

• Provide data analysis, transactional support, error detection, resolution, and ongoing support for EDI operations

• Perform analysis and validation of Medicaid 8001 transaction files

• Review and resolve data issues related to master data, master person identifiers, and other system data discrepancies

• Perform system error analysis and root cause investigation

• Validate 1095-A and 1095-B files and reconcile 8001 transactions

• Analyze inbound and outbound EDI files exchanged with carriers, managed care organizations, and external partners

• Identify EDI file rejections, analyze root causes, and recommend corrective actions

• Analyze EDI 999 acknowledgment files and assist with resolving exceptions and data issues

• Coordinate with development, business, and testing teams to analyze, fix, test, and transmit EDI files on a daily or as needed basis

• Perform data corrections to resolve consumer- or system-reported issues

• Access databases and applications to perform root cause analysis and implement data fixes

• Translate business needs into technical EDI data solutions

• Communicate effectively with IT teams, business users, vendors, and stakeholders

• Support flexible work schedules, including off-hours, weekends, and holidays as required

• Bachelor’s degree in Computer Science, Information Systems, Engineering, Business, or a related field

• Minimum 4 years of experience working with healthcare marketplace or eligibility-based EDI solutions

• Minimum 4 years of experience creating and processing EDI X12 transaction sets such as 834, 999, and TA1

• Minimum 4 years of experience reviewing and interpreting EDI companion guides and implementation guides

• Minimum 4 years of experience analyzing, testing, and providing data solutions for healthcare or eligibility systems

• Minimum 2 years of experience working with SQL databases and writing SQL queries

• Strong analytical and problem-solving skills

• Excellent communication skills with the ability to translate technical concepts for business users

• Ability to manage multiple priorities and meet tight deadlines

• 6+ years of experience using EDI validation tools such as Edifecs, WTX, or equivalent

• 6+ years of experience working with EDI transaction sets including 834, 820, 999, and TA1

• Hands-on experience writing complex SQL scripts

• Knowledge of Affordable Care Act (ACA) eligibility rules for Medicaid and Qualified Health Plans

• Experience with or knowledge of Medicaid 8001 file processing or other inter-agency transactional file processing

• In-depth understanding of EDI 834 enrollment transactions, including adds, changes, terminations, cancellations, and error processing