EDI Analyst -X12 835 files

Zelis; Missouri; Remote; USD 60,000 - 100,000; Full time

Job summary

An established industry player is seeking EDI Analysts to join their dynamic team. This role focuses on enhancing healthcare claim lifecycle solutions through meticulous analysis and troubleshooting of EDI files. The ideal candidate will leverage their EDI expertise and SQL skills to support client implementations and ensure compliance with HIPAA standards. In this fast-paced environment, you will collaborate with various departments and manage multiple projects simultaneously, making a significant impact on client satisfaction and operational efficiency. If you are driven by challenges and have a passion for healthcare technology, this opportunity is perfect for you.

Qualifications

• 3+ years of EDI experience, including 1 year in healthcare.
• User acceptance testing and technical solution design skills.

Responsibilities

• Review X12 835 files for issues and develop strategies to solve them.
• Support client implementation activities by generating and reviewing 835 files.

Skills

EDI experience

SQL

Technical solution guidance

Critical thinking

Presentation skills

Tools

SQL Management Studio

Advanced test editors

Job description

Zelis is pursuing an aggressive organic and non-organic growth strategy focused on providing superior healthcare claim lifecycle solutions to payors, providers, and individuals from pre-payment through payment. As the company executes its growth strategy, Zelis is currently hiring EDI Analysts. The position will report to an EDI Manager and will work closely with managers and various team members.

Hiring remote at these locations:

1. Morristown, NJ
2. Atlanta, GA
3. St Louis, MO
4. St Pete, FL
5. Plano, TX

Responsibilities:

1. Use advanced test editors and other technology tools to review X12 835 files for issues, including but not limited to balance, structure, syntactical, data type, and content errors; develop and execute strategies to solve them.
2. Troubleshoot by querying the database using SQL Management Studio to review stored values and/or using a text editor to manually review data files sent to Zelis by our Payer clients.
3. Support Payer and Provider client implementation activities by generating 835 files, reviewing content, and presenting findings to Zelis clients.
4. Respond to inquiries regarding 835 issues, claims, payments, and/or clearinghouse activities.
5. Interact with other departments on communication issues related to customer and third-party vendor connectivity.
6. User acceptance testing to approve items for release.
7. Communicate with vendor contacts to identify file issues and disseminate the resolution to the provider or payer to maintain compliance with all HIPAA and Zelis data security standards.
8. Support multiple client projects simultaneously.
9. Ensure proper follow-up and completion of projects.
10. Work under pressure with multiple deadlines.
11. Work on assignments that are complex in nature in which judgment, critical thinking, and initiative are required to accomplish the objectives of the assignment.

REQUIRED EXPERIENCE:

1. 3+ years EDI experience to include 1 year of healthcare.
2. Technical solution guidance & design – user acceptance testing.
3. Create, lead, and facilitate presentations to Operations team, and internal & external stakeholders & clients.

PREFERRED EXPERIENCE:

1. EDI files (fixed length, delimited, X12 and/or EDI 835) and adjudication systems.
2. SQL knowledge.
3. Advanced test editors or other technology tools.
4. Provider billing and/or claims payment experience helpful.