Senior EDI Analyst: 835 ERA & AI-Driven Billing

Zelis Healthcare, LLC; Creve Coeur (MO); Hybrid; USD 65,000 - 82,650; Full time

Benefits offered by this job

401k with employer match

Health benefits

Job summary

Zelis Healthcare, LLC in the United States is seeking an experienced EDI Analyst II to support and optimize healthcare EDI integrations, with a primary focus on ANSI X12 5010 835 ERA transactions. You will troubleshoot complex issues, improve automation and AI-enabled workflows, and ensure data accuracy and HIPAA compliance.

Collaborating with cross-functional teams and external partners, you will design mappings, validation plans, and testing, while mentoring junior analysts and staying current

Qualifications

• Bachelor’s degree or equivalent experience in a related field.
• 5-7+ years of healthcare EDI experience, with 3-5+ years on ANSI X12 835.
• Strong knowledge of HIPAA ANSI X12 and trading partner requirements.
• Experience with EDI validation tools and data mapping.
• Advanced SQL and data analysis skills; familiarity with SQL Server.

Responsibilities

• Analyze and troubleshoot ANSI X12 5010 835 (ERA) transactions and related issues.
• Perform root cause analysis, resolve EDI processing problems, and implement preventive solutions.
• Design and maintain EDI integration workflows, data mappings, and testing plans.
• Interpret payer/provider specifications to ensure HIPAA and partner compliance.
• Generate, validate, and review EDI files and communicate findings to teams/clients.
• Serve as technical point of contact for escalated remittance and clearinghouse issues.
• Collaborate with internal teams, clients, vendors, and partners to resolve integration challenges.
• Leverage AI-enabled tools to improve data quality and operational efficiency.
• Document best practices and mentor junior analysts; stay current with EDI standards.
• Identify process improvements and ensure ongoing HIPAA compliance.

Skills

EDI analysis

SQL skills

Analytical abilities

Mentoring

Communication

Education

Bachelor’s degree in Information Systems, Healthcare Administration, Computer Science, or related field

Tools

Edifecs

Crystal Validation

SQL Server

Jira

Notepad++

AI tools

Job description

Zelis Healthcare, LLC in the United States is seeking an experienced EDI Analyst II to support and optimize healthcare EDI integrations, with a primary focus on ANSI X12 5010 835 ERA transactions. You will troubleshoot complex issues, improve automation and AI-enabled workflows, and ensure data accuracy and HIPAA compliance.

Collaborating with cross-functional teams and external partners, you will design mappings, validation plans, and testing, while mentoring junior analysts and staying current