Systems Analyst (EDI)

Responsibilities

• 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.

Requirements

• 8 plus years 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.

Preferred

• 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.