Lead Edifecs Analyst

Simplify Alpha; Northern (KY); On-site; USD 160,000 - 210,000; Full time

Job summary

Simplify Alpha is seeking a Lead Edifecs Analyst to serve as the primary client-facing technical authority on the Edifecs-based EDI integration layer of our healthcare core administration platform. You will own the solution design, translate requirements with client stakeholders, and mentor an offshore Edifecs analyst team to ensure high-quality builds.

You will personally validate the technical build, lead design sessions, and ensure compliance with HIPAA and regulatory requirements while

Qualifications

• 12–15 years of healthcare EDI/integration engineering with deep, hands-on Edifecs expertise.
• Hands-on expertise in Edifecs product suite (e.g., SpecBuilder, XEngine, Transaction/EDI Gateway, Encounter Management).
• Strong, hands-on J2EE experience for customizing Edifecs and related components.
• Experience with MongoDB, PostgreSQL, and Oracle databases supporting EDI/integration platforms.
• Deep knowledge of HIPAA X12 EDI transactions: 270/271, 834, 835/837, 275, 276/277.

Responsibilities

• Serve as primary client-facing technical lead for Edifecs-based EDI integration.
• Own end-to-end design of Edifecs configurations, maps, and validation rules for X12.
• Lead requirements-gathering and solution-design sessions with client stakeholders.
• Translate regulatory and trading-partner requirements into Edifecs specs and validate build before go-live.
• Provide technical leadership to offshore Edifecs analyst team through design reviews.
• Own escalation and resolution of complex production issues across Edifecs flows.
• Partner with architecture and platform teams to align Edifecs integration with broader roadmap.
• Define and enforce standards for Edifecs configuration management and testing.
• Own status reporting and risk/issue communication to stakeholders.
• Drive adoption of AI-assisted engineering practices across the team.

Skills

Edifecs

J2EE

Healthcare EDI

Leadership

Client engagement

Regulatory compliance

Education

Bachelor's degree in Computer Science or related field

Tools

Edifecs SpecBuilder

Edifecs XEngine

MongoDB

PostgreSQL

Oracle

Job description

We are looking for a Lead Edifecs Analyst to serve as the primary client-facing technical authority on our large healthcare core administration platform's EDI integration layer. This is a leadership role: you will own solution design and requirements translation directly with client business, compliance, and technical stakeholders, and you will lead and mentor the offshore Edifecs analyst team that builds and supports the day-to-day configurations. Deep, current, hands‑on Edifecs expertise is essential; this is not a purely managerial role, you are expected to personally understand and validate the technical build.

KeyResponsibilities:

• Serve as the primaryclient-facing technical lead for Edifecs-based EDI integration across the coreadministration platform (claims, eligibility, enrollment, encounters,remittance)
• Own end-to-end design ofEdifecs trading partner configurations, transaction maps, and validation rulesfor X12 transactions (270/271, 834, 835/837, 275, 276/277)
• Lead requirements-gathering andsolution-design sessions directly with client business, compliance, andtechnical stakeholders
• Translate complex regulatory,payer, and trading-partner requirements into Edifecs specifications, andvalidate that the completed build meets those requirements before go-live
• Provide technical leadership and mentorship to the offshore Edifecs analyst team, reviewing designs, code, and configurations for quality and compliance
• Own escalation and resolutionof complex production issues across Edifecs EDI flows, coordinating acrossclient, offshore, and platform teams
• Partner with architecture andplatform teams to align Edifecs-based integration with the broader coreadministration platform roadmap, including modernization initiatives
• Define and enforce standardsfor Edifecs configuration management, version control, testing, and changemanagement
• Own status reporting andrisk/issue communication to client stakeholders and program leadership
• Drive adoption of AI-assistedengineering practices across the Edifecs analyst team

Required Qualifications:

• Bachelor's degree in ComputerScience, Engineering, or a related field
• 12–15 years of experience inhealthcare EDI/integration engineering, with deep, hands‑on expertise in theEdifecs product suite (e.g., SpecBuilder, XEngine, Transaction/EDI Gateway,Encounter Management)
• Strong, hands‑on expertise inJ2EE for customizing and extending Edifecs and related integration components
• Strong, hands‑on experience with MongoDB, PostgreSQL, and Oracle databases supporting EDI/integration platforms
• Deep working knowledge of core HIPAA X12 EDI transactions: 270/271 (eligibility), 834 (enrollment), 835/837(remittance advice/claims), 275 (claim attachment), and 276/277 (claim status inquiry/response)
• Proven experience leading Edifecs implementations end-to-end, from requirements through go-live, in a health plan/payer core administration environment
• Experience directly managing client relationships and leading distributed onshore/offshore technical teams
• Strong understanding of healthcare compliance and regulatory requirements affecting EDI transactions(HIPAA, CAQH CORE operating rules)
• Excellent verbal and written communication skills, including experience presenting to client executives and compliance stakeholders

AI Knowledge & AI‑Assisted Development (Required):

• Practical, daily use of AIcoding/assistant tools to accelerate Edifecs map/transformation development,J2EE customization, and technical documentation
• Able to critically review andvalidate AI-generated maps, code, and configurations for correctness andregulatory compliance before deployment
• Able to define and enforcestandards for responsible AI tool usage across the team, including strictprohibitions on entering PHI, member data, or other sensitive information intoprompts or external AI tools
• Able to identify opportunitieswhere AI-driven automation can improve EDI mapping, testing, or documentationefficiency, and lead adoption across onshore/offshore teams
• Comfortable evaluating andchampioning AI-assisted approaches as part of broader platform modernizationinitiatives

Preferred Qualifications:

• Direct experience working foror with a health plan/payer organization on core administration systems (e.g.,Facets, QNXT, HealthRules)
• CAQH CORE certification orhands-on operating-rule compliance experience
• Experience integrating Edifecswith mainframe or cloud-based core administration platforms
• Relevant certifications: Edifecs product certifications, Oracle or PostgreSQL DBA certifications

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