Healthcare EDI Specialist

Job Summary :

We are seeking an experienced EDI Analyst to support healthcare claims integrations and electronic data interchange (EDI) processes. The ideal candidate will have deep expertise in 837 (claims) and 835 (remittance) file formats, a strong understanding of healthcare claims workflows, and experience working with cross-functional teams to ensure smooth implementation and ongoing operations.

Key Responsibilities :

• Analyze and manage EDI file processes including 837 (claims) and 835 (remittance) transactions.
• Support the onboarding of new clients by configuring EDI integrations and validating data exchange protocols.
• Collaborate with engineering, client delivery teams, and QA to troubleshoot EDI-related issues and ensure successful data transmissions.
• Partner with :
• Red Team on legacy systems support (e.G., Impact).
• Yellow Team on forward-looking initiatives like centralized integrations and web portal enhancements.
• Support ongoing platform operations, including resolving production issues, implementing enhancements, and participating in system upgrades.
• Conduct root cause analysis for EDI-related issues and recommend process improvements.
• Act as a Subject Matter Expert (SME) on healthcare claims adjudication and EDI transaction standards.
• Maintain up-to-date documentation for EDI workflows, data mappings, and system configurations.

Required Qualifications :

Preferred Qualifications :