Healthcare Data Exchange Analyst - Eligibility & EDI

Capital Rx; New York (NY); Hybrid; USD 81,000 - 121,000; Full time

Job summary

Judi Health is a health technology company delivering benefit administration solutions to employers, unions, health plans, and government entities. The role focuses on eligibility processing, EDI, and data integrity across client implementations in a hybrid work model with offices in NYC, Denver, and Charlotte.

The candidate will coordinate eligibility data transfers, ensure accuracy, and collaborate with internal and external partners to meet service levels and standards.

Qualifications

• Bachelor's degree required.
• 1+ years in PBM/Healthcare/Data Exchange.
• Ability to map PBM concepts across systems.
• Strong data analysis and problem-solving skills."

Responsibilities

• Attend new client implementation meetings with external partners to discuss eligibility requirements and protocols.
• Recommend eligibility file formats to external partners and coordinate receipt and processing of eligibility data.
• Act as a healthcare data SME on Eligibility guidelines and EDI protocols.
• Coordinate eligibility issue identification and resolution with internal teams and external partners.
• Identify and triage eligibility issues and support resolution of data transfer errors.
• Monitor system status and eligibility data to identify abnormalities impacting quality and accuracy.
• Ensure issues are resolved within operating standards and service levels.
• Assist validation of eligibility data integrity through audits and reconciliation.

Skills

PBM knowledge

Healthcare data

SQL

Excel

JSON

Communication

Problem-solving

Education

Bachelor's degree

Job description

Judi Health is a health technology company delivering benefit administration solutions to employers, unions, health plans, and government entities. The role focuses on eligibility processing, EDI, and data integrity across client implementations in a hybrid work model with offices in NYC, Denver, and Charlotte.

The candidate will coordinate eligibility data transfers, ensure accuracy, and collaborate with internal and external partners to meet service levels and standards.