Job ID: 1893
Role Overview
We are seeking a highly skilled and detail-oriented Senior EDI Healthcare Systems Analyst to join our specialized team in Baltimore, MD. This position operates on a hybrid work model, requiring a professional who can balance remote productivity with onsite collaboration. The successful candidate will play a pivotal role in the Electronic Data Interchange (EDI) operations of the Health Exchange, ensuring that critical healthcare data is processed accurately and efficiently. This role is essential for maintaining the integrity of data exchanged between the marketplace, carriers, and Managed Care Organizations (MCOs). You will be responsible for the end-to-end lifecycle of EDI transactions, from initial analysis and validation to error resolution and technical solutioning.
Key Responsibilities
- Provide expert-level data analysis and transactional support for the Exchange’s EDI operations.
- Perform deep-dive analysis and validation of 8001 Medicaid transaction files to ensure compliance with state and federal regulations.
- Review and resolve complex data issues involving Master Data Management (MDM) and Master Person Identifier (MPI) systems.
- Conduct thorough HBX System Error analysis to identify and mitigate systemic data discrepancies.
- Validate 1095-A and 1095-B files and perform comprehensive reconciliation of 8001 transactions.
- Analyze EDI files sent to and received from external entities, identifying root causes for file rejections and implementing corrective actions.
- Collaborate closely with development, business, and testing teams to facilitate the daily transmission of EDI files.
- Perform root cause analysis for exceptions in EDI 999 files received from Carriers and MCOs.
- Execute data changes to fix consumer-reported or system-detected errors, utilizing SQL to perform data fixes.
- Translate complex business requirements into technical EDI specifications and data solutions.
- Communicate effectively with IT teams, vendors, and stakeholders to ensure alignment on EDI data fixes.
Technical Qualifications
- A minimum of four (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 documents such as companion and implementation guides for Healthcare EDI formats.
- At least six (6) years of experience with EDI validation tools such as Edifecs, WTX, or equivalent industry-standard software.
- Strong proficiency in writing complex SQL scripts for data analysis and database manipulation (minimum 2 years).
- In-depth understanding of the Affordable Care Act (ACA) eligibility rules for Medicaid and Qualified Health Plans.
- Comprehensive knowledge of EDI 834 enrollment transactions, including Adds, Changes, Terminations, and Cancellations.
Education and Professional Requirements
- Bachelor’s Degree from an accredited institution in Computer Science, Systems Analysis, or Information Systems.
- A Master’s Degree in a related Information Technology field is highly preferred.
- Must possess an active LinkedIn profile for professional verification.
- Excellent analytical, problem-solving, and communication skills are mandatory.
- Ability to manage multiple critical priorities and meet tight deadlines in a high-pressure environment.
Impact and Environment
As a Senior EDI Healthcare Systems Analyst, your work directly impacts the accessibility and accuracy of healthcare coverage for thousands of individuals. You will work in a sophisticated technical environment that values precision and proactive problem-solving. This role offers the opportunity to work with cutting-edge healthcare IT systems and contribute to the continuous improvement of the state’s health exchange infrastructure. We are looking for a dedicated professional who is passionate about data integrity and the intersection of technology and healthcare policy.
Special Requirements
Active LinkedIn profile required. Hybrid work model in Baltimore, MD. Mandatory knowledge of ACA eligibility and Medicaid 8001 file processing.
Compensation & Location
Salary: $115,000 – $155,000 per year (Estimated)
Location: Baltimore, MD
Recruiter / Company – Contact Information
Recruiter / Employer: Vyze Inc
Email: anuj@vyzeinc.com
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