EDI Analyst

MetroPlus; New York (NY); On-site; USD 75,000 - 95,000; Full time

Job summary

A healthcare organization in New York seeks an EDI Analyst responsible for ensuring accurate data exchange through HIPAA-compliant EDI transactions. The role includes configuring and maintaining EDI processes, resolving transaction errors, and liaising with vendors and internal teams. The ideal candidate has a Bachelor’s Degree in Computer Science, five years of experience in healthcare data analysis, and is skilled in Microsoft Office and SQL. This position plays a pivotal role in operational performance and compliance.

Qualifications

• Minimum five years of full-time experience analyzing healthcare-related data.
• Experience with HIPAA data transactions required.
• Detail-oriented and able to work independently.

Responsibilities

• Configure, test, maintain, enhance, and support HIPAA EDI transactions.
• Implement new Companion Guides and Trading Partner Agreements.
• Support day-to-day operations of EDI.

Skills

HIPAA EDI transactions

Data analysis

Communication skills

Project management

Education

Bachelor’s Degree in Computer Science or related discipline

Tools

Microsoft Office

SQL

Access queries

Job description

Seeking an EDI Analyst responsible for implementing, maintaining, and supporting Electronic Data Interchange (EDI) transactions to ensure accurate, HIPAA-compliant data exchange among healthcare providers, clearinghouses, and payers. The role involves resolving transaction errors affecting claims, eligibility, and remittances while collaborating closely with IT, revenue cycle teams, and external trading partners to configure, test, monitor, and troubleshoot EDI data flows. By ensuring reliable transmission and processing of key healthcare transactions—including claims, eligibility, claim status, authorizations, and remittance—the EDI Analyst plays a critical role in maintaining smooth operational performance

Scope of Role & Responsibilities

• Responsible for configuring, testing, maintaining, enhancing, and supporting HIPAA EDI (837, 835, 834, 270, 271, 276, 277, 278) transactions and applications
• Implement new and update existing Companion Guides and Trading Partner Agreements
• Support day-to-day operations of EDI, including identifying any technical problems with sending/receiving transactions
• Interact with Trading Partners, providers, vendors and internal departments to address technical issues related to EDI
• Review electronic data received from providers/vendors to ensure presence and accuracy of critical data elements
• Liaison between the business users and technical teams to build and improve the system based on business needs and requirements
• Coordinate and establish a great relationship with External Vendors and work very closely to meet their needs
• Create and simplify EDI Export and Import processes and collaborate with EDI trading partners, payers or vendors
• Coordinate with our vendors, open cases on the issues at a system functionality level, and support the internal business stakeholders
• Create business use case scenarios, document system specifications from information obtained through committee meetings, and generate various processes for other resources in the team to help them troubleshoot the issue in the future
• Acquire and evaluate all project documentation for testing and compliance to meet quality assurance requirements
• Maintain upkeep of system setup and processes to ensure accurate and optimum setup for both provider and member selection

Required Education, Training & Professional Experience

• Bachelor’s Degree in Computer Science or a related technical discipline
• Minimum five years of full-time experience analyzing health care related data in a health-care environment
• Experience with HIPAA data transaction required
• Proficient in use of Microsoft Office applications
• Ability to run Access queries and SQL required

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Must be able to work independently and to attend to detail
• Excellent written and verbal communication skills as well as strong project management and data analysis skills