Lead Edifecs Analyst – Healthcare EDI

Triveni IT; United States; Remote; USD 140,000 - 190,000; Full time

Job summary

Triveni IT seeks an experienced Lead Edifecs Analyst to direct healthcare EDI integration initiatives on a large-scale health plan core administration platform. The role requires deep Edifecs expertise, HIPAA X12 proficiency, and strong collaboration with payer systems.

You will lead end-to-end Edifecs implementations, act as the primary technical liaison, and drive design, configuration, and validation of maps and workflows across onshore and offshore teams.

Qualifications

• Bachelor's degree in Computer Science, Engineering, or a related discipline.
• 12–15 years of experience in healthcare EDI, integration engineering, or related healthcare technology environments.
• Extensive, current, hands-on experience with the Edifecs product suite, including SpecBuilder, XEngine, EDI Gateway, and Encounter Management.
• Strong hands-on J2EE development and customization experience.
• Practical experience with MongoDB, PostgreSQL, and Oracle databases.
• Deep knowledge of HIPAA X12 transactions: 270/271, 834, 835/837, 275, and 276/277.
• Direct experience working with health plans, healthcare payers, or payer core administration platforms such as Facets, QNXT, or HealthRules.
• Demonstrated experience leading end-to-end Edifecs implementations in a payer environment.
• Proven client-facing leadership, requirements analysis, solution design, and offshore team management experience.
• Strong knowledge of HIPAA compliance, CAQH CORE operating rules, and healthcare EDI standards.
• Practical experience using AI coding assistants for development, mapping, testing, or documentation, with the ability to validate AI-generated outputs for technical accuracy and regulatory compliance.
• Excellent communication, stakeholder management, and technical presentation skills.

Responsibilities

• Lead end-to-end Edifecs implementations from requirements through go-live.
• Serve as the primary technical liaison for client stakeholders.
• Design, configure, review, and validate Edifecs maps, transformations, and workflows.
• Lead implementation and processing of HIPAA X12 transactions (270/271, 834, 835, 837, 275, 276/277).
• Customize and extend integration components using J2EE and related technologies.
• Work with MongoDB, PostgreSQL, and Oracle databases.
• Integrate Edifecs with payer core platforms such as Facets, QNXT, HealthRules.
• Ensure compliance with HIPAA requirements and CAQH CORE rules.
• Lead and coordinate onshore/offshore teams; maintain quality and standards.
• Troubleshoot complex EDI processing issues and production incidents.
• Utilize AI-assisted tools while validating all outputs.

Skills

Edifecs

J2EE

HIPAA X12

Client leadership

Stakeholder management

AI-assisted development

Education

Bachelor's degree in CS/Engineering

Tools

SpecBuilder

XEngine

EDI Gateway

Encounter Management

MongoDB

PostgreSQL

Oracle

Job description

Location: Remote – USA

Experience: 12–15 Years

Work Authorization: US Citizens (USC) / Green Card Holders (GC)

Job Overview

We are seeking an experienced Lead Edifecs Analyst to lead healthcare EDI integration initiatives for a large-scale health plan core administration platform. This role requires deep, hands-on expertise in the Edifecs product suite, HIPAA X12 EDI transactions, and healthcare payer systems.

Key Responsibilities

• Lead end-to-end Edifecs implementations, from requirements gathering and solution design through development, testing, deployment, and go-live.
• Serve as the primary technical liaison for client business, compliance, and technology stakeholders.
• Design, configure, review, and validate Edifecs maps, transformations, and integration workflows using SpecBuilder, XEngine, EDI Gateway, and Encounter Management.
• Lead the implementation and processing of HIPAA X12 transactions, including 270/271, 834, 835, 837, 275, and 276/277.
• Customize and extend integration components using J2EE and related technologies.
• Work with MongoDB, PostgreSQL, and Oracle databases to support healthcare EDI integration platforms.
• Integrate Edifecs solutions with payer core administration platforms such as Facets, QNXT, and HealthRules.
• Ensure compliance with HIPAA requirements and CAQH CORE operating rules.
• Lead, mentor, and coordinate onshore/offshore technical teams, ensuring delivery quality and adherence to technical standards.
• Troubleshoot complex EDI processing issues, mapping defects, transaction validation failures, and production incidents.
• Leverage AI-assisted development tools to accelerate mapping, coding, testing, and technical documentation while independently validating all generated outputs.
• Establish responsible AI usage standards, ensuring that PHI, member information, and other sensitive data are never entered into unauthorized AI tools.
• Identify opportunities to improve EDI automation, testing efficiency, documentation, and platform modernization.

Required Qualifications

• Bachelor's degree in Computer Science, Engineering, or a related discipline.
• 12–15 years of experience in healthcare EDI, integration engineering, or related healthcare technology environments.
• Extensive, current, hands-on experience with the Edifecs product suite, including SpecBuilder, XEngine, EDI Gateway, and Encounter Management.
• Strong hands-on J2EE development and customization experience.
• Practical experience with MongoDB, PostgreSQL, and Oracle databases.
• Deep knowledge of HIPAA X12 transactions: 270/271, 834, 835/837, 275, and 276/277.
• Direct experience working with health plans, healthcare payers, or payer core administration platforms such as Facets, QNXT, or HealthRules.
• Demonstrated experience leading end-to-end Edifecs implementations in a payer environment.
• Proven client-facing leadership, requirements analysis, solution design, and offshore team management experience.
• Strong knowledge of HIPAA compliance, CAQH CORE operating rules, and healthcare EDI standards.
• Practical experience using AI coding assistants for development, mapping, testing, or documentation, with the ability to validate AI-generated outputs for technical accuracy and regulatory compliance.
• Excellent communication, stakeholder management, and technical presentation skills.