Job ID: JOB_ID_942
Role Overview
Miracle Software Systems is seeking a highly skilled Senior Systems Analyst specializing in Electronic Data Interchange (EDI) to join our team in Baltimore, MD. This is a critical 12-month contract position focused on supporting the Health Exchange marketplace. The successful candidate will be responsible for providing comprehensive data analysis, transactional support, and error resolution services to ensure the seamless operation of EDI systems. This role requires a deep understanding of healthcare transaction sets, specifically within the context of the Affordable Care Act (ACA) and Medicaid frameworks.
Key Responsibilities
- Provide expert-level data analysis and transactional support for the Exchange’s EDI operations, ensuring high availability and data integrity.
- Perform detailed analysis and validation of 8001 Medicaid transaction files to ensure compliance with state and federal regulations.
- Identify, review, and resolve complex data issues involving Master Data Management (MDM) and Master Person Identifier (MPI) systems.
- Conduct root cause analysis for HBX System Errors and implement effective technical solutions to prevent recurrence.
- Validate 1095-A and 1095-B tax files and perform reconciliation of 8001 transactions to maintain financial and reporting accuracy.
- Analyze inbound and outbound EDI files from Carriers and Managed Care Organizations (MCOs), identifying root causes for file rejections and exceptions.
- Collaborate closely with cross-functional teams, including development, business, and testing units, to facilitate daily EDI file transmissions.
- Utilize SQL databases to perform data changes, fix consumer-reported errors, and extract actionable insights from complex datasets.
- Translate complex business requirements into technical EDI specifications and data fix solutions for various stakeholders.
- Manage multiple high-priority tasks and adhere to strict deadlines within a fast-paced healthcare IT environment.
Technical Requirements
- Minimum of 4 years of direct experience with Health Exchange marketplace EDI solutions.
- Extensive experience (4+ years) creating and managing EDI X12 files, specifically transaction sets 834, 999, and TA1.
- Proven ability to interpret technical documentation, including companion guides and implementation guides for Healthcare EDI formats.
- At least 2 years of hands-on experience writing complex SQL queries and scripts for data manipulation and analysis.
- Preferred experience with EDI validation tools such as Edifecs or WTX.
- Knowledge of ACA eligibility rules for Medicaid and Qualified Health Plans (QHP) is highly desirable.
- Experience with Medicaid 8001 file processing or similar inter-agency transactional workflows.
About Miracle Software Systems
Miracle Software Systems, Inc. is a global systems integrator and a leader in the IT services industry. Headquartered in Novi, Michigan, we specialize in providing innovative technology solutions to Fortune 1000 companies. Our expertise spans across Integration, Cloud, Data & Analytics, and Digital Experience. Joining Miracle means becoming part of a diverse and dynamic team dedicated to driving digital transformation for our clients worldwide.
Special Requirements
Domain restriction: Healthcare/Health Exchange marketplace. Experience with Medicaid 8001 file processing preferred.
Compensation & Location
Salary: $115,000 – $165,000 per year (Estimated)
Location: Baltimore, MD
Recruiter / Company – Contact Information
Recruiter / Employer: Miracle Software Systems, Inc.
Email: usabarinadh@miraclesoft.com
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