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Healthcare EDI Systems Analyst (Remote)

Conexess Group

Role overview

Qualifications

  • Bachelor's degree in Information Systems, Healthcare Informatics, Computer Science, Health Information Management, or related field (or equivalent experience)
  • 3+ years of healthcare EDI experience
  • Experience supporting HIPAA X12 transactions, healthcare claims, eligibility, remittance, enrollment, and revenue cycle processes
  • Experience working with providers, payers, clearinghouses, or healthcare technology organizations

Responsibilities

  • Monitor daily EDI transaction processing and error queues
  • Troubleshoot and resolve issues with claims, eligibility, remittance, authorization, and enrollment transactions
  • Support HIPAA X12 transaction workflows
  • Translate business requirements into technical EDI solutions

About the company

Conexess Group logo

Conexess Group

Staffing & Recruiting

Conexess Group is a staffing and consulting solutions provider that combines the technology you need with relationships you can trust. We understand that one size never fits all, which is why we work with our clients to develop specialized solutions that fit their organizations, coupled with responsive service that ensures we get the job done right. By getting to know our clients on a deeply personal level, we unlock the potential of our elite technical knowledge and talent network, granting access to game-changing consultants and concierge-level service. And our 80 years of combined experience enables us to attract only the best specialized talent, whom we always treat with the utmost respect and professionalism. In fact, many of our consultants have come to view Conexess as a career counselor, providing constant updates on the latest opportunities. Our culture and values reflect our innovative approach toward attracting and retaining the most talented experts and producing consistent results for our Fortune 500 and mid-cap clients. Known for our technological leadership and entrepreneurial passion, our firm has been delivering value to our clients by providing solutions to their most complex challenges. Whether you’re in need of specialized talent or a boost to your career, we look forward to working with you. Specialties: IT Staff Augmentation | ERP Consulting Solutions | Accounting & Finance Recruitment

Company details

Company typeSME
IndustryStaffing & Recruiting
Company size51 - 200

Links

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Job description

Conexess Group is aiding a large healthcare client in their search for a Healthcare EDI Systems Analyst in a remote capacity. This is a long term contract opportunity with a competitive compensation package.
 
Please note we are unable to provide sponsorship or work c2c for this role.

The Healthcare EDI Systems Analyst is responsible for the implementation, support, monitoring, analysis, and optimization of Electronic Data Interchange (EDI) transactions across healthcare operations. This role ensures the accurate, secure, and HIPAA-compliant exchange of data between providers, payers, clearinghouses, government agencies, and third-party vendors.
Serving as the primary liaison between business stakeholders, healthcare operations, application support teams, and external trading partners, the analyst supports healthcare claims processing, revenue cycle operations, system integrations, and regulatory compliance.

Responsibilities
EDI Operations & Transaction Management
  • Monitor daily EDI transaction processing and error queues.
  • Troubleshoot and resolve issues with claims, eligibility, remittance, authorization, and enrollment transactions.
  • Ensure timely processing of inbound and outbound healthcare transactions.
  • Manage acknowledgments, reconciliations, and production support with minimal business disruption.
  • Coordinate issue resolution with providers, payers, clearinghouses, and vendors.
Healthcare Claims & Revenue Cycle Support
Support HIPAA X12 transaction workflows, including:
  • Claims: 837P, 837I, 837D
  • Eligibility: 270/271
  • Claim Status: 276/277
  • Prior Authorization: 278
  • Payments: 835 ERA and EFT reconciliation
  • Enrollment: 834
  • Acknowledgments: 999, 277CA, TA1
EDI Development & Integration
  • Translate business requirements into technical EDI solutions.
  • Design, develop, test, and implement EDI maps, workflows, and integrations.
  • Support integrations between EDI platforms and healthcare applications.
  • Configure communication protocols including AS2, SFTP, APIs, HTTPS, and secure web services.
  • Create mapping documentation and support system migrations and upgrades.
Healthcare Systems Support
Support and integrate healthcare applications including Epic, Cerner (Oracle Health), Meditech, Athenahealth, NextGen, eClinicalWorks, Allscripts/Veradigm, HealthEdge, Facets, QNXT, GuidingCare, and custom claims processing platforms.
Compliance & Trading Partner Management
  • Ensure compliance with HIPAA EDI standards and regulatory requirements.
  • Support CMS, Medicare, Medicaid, and commercial payer transactions.
  • Participate in audits, security reviews, and compliance documentation.
  • Onboard healthcare trading partners, coordinate connectivity and certification testing, maintain partner profiles, and serve as the escalation point for transaction issues.
Data Analysis & Reporting
  • Perform root cause analysis for transaction failures and claims processing issues.
  • Analyze data quality impacting reimbursement and member services.
  • Develop operational reports, dashboards, KPIs, and transaction performance metrics.
Qualifications
  • Bachelor's degree in Information Systems, Healthcare Informatics, Computer Science, Health Information Management, or related field (or equivalent experience).
  • 3+ years of healthcare EDI experience.
  • Experience supporting HIPAA X12 transactions, healthcare claims, eligibility, remittance, enrollment, and revenue cycle processes.
  • Experience working with providers, payers, clearinghouses, or healthcare technology organizations.
Technical Knowledge
Strong understanding of:
  • ANSI X12, HIPAA EDI, NCPDP, HL7, FHIR APIs, XML, and JSON.
  • Healthcare transactions including 834, 835, 837, 270/271, 276/277, 278, 999, and TA1.
  • One or more EDI platforms such as IBM Sterling B2B Integrator, Edifecs, Optum Intelligent EDI, OpenText, Cleo Integration Cloud, MuleSoft, Boomi, Cognizant TriZetto, HealthEC, or Oracle Integration Cloud.
Technical Competencies
  • SQL and data analysis
  • Healthcare data mapping and EDI troubleshooting
  • API integrations and data validation
  • Healthcare claims processing systems
  • Windows/Linux administration
  • Scripting (PowerShell, Python, or Shell)
Preferred
  • CPHIMS or Healthcare Informatics certification.
  • Experience with healthcare clearinghouses.
  • Medicare/Medicaid knowledge.
  • HL7/FHIR integrations.
  • Cloud integration platforms (Azure, AWS, or Google Cloud).
  • Knowledge of value-based care and population health data exchanges.
 
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