Senior EDI Analyst, 835 & Healthcare Integration

Zelis Healthcare, LLC; Creve Coeur (MO); Hybrid; USD 65,000 - 83,000; Full time

Benefits offered by this job

401k with company match

Medical, dental, vision benefits

Flexible PTO

Job summary

Zelis Healthcare, LLC is seeking an experienced EDI Integration Analyst to support the integration of systems, applications, and data sources for efficient operations. You will work with cross-functional teams to analyze requirements, design solutions, and implement integration processes.

You will analyze and troubleshoot ANSI X12 5010 835 transactions, perform root cause analysis, and design EDI workflows. The role emphasizes HIPAA compliance and collaboration with clients and trading partners.

Qualifications

• Bachelor's degree or equivalent experience in Information Systems, Healthcare Administration, Computer Science, or related field.
• 5-7+ years of healthcare EDI experience, including 3-5+ years supporting HIPAA ANSI X12 835 transactions; 837, 834, 270/271 a plus.
• Advanced SQL and data analysis skills; experience with SQL Server is preferred.

Responsibilities

• Analyze and troubleshoot ANSI X12 5010 835 (ERA) transactions, identifying processing, formatting, balancing, and compliance issues.
• Perform root cause analysis, resolve EDI processing issues, and implement preventive solutions.
• Design and maintain EDI integration workflows, data mappings, technical documentation, and testing plans.
• Interpret payer and provider specifications to ensure HIPAA, ANSI X12, and trading partner requirements.
• Generate, validate, and review EDI files, communicating findings and recommendations to internal teams and clients.
• Serve as the technical point of contact for escalated 835 remittance, provider payment, and clearinghouse issues.
• Partner with internal teams, clients, vendors, and trading partners to resolve integration, connectivity, and workflow challenges.
• Leverage AI-enabled tools and automation to improve data quality, validation, reconciliation, and operational efficiency.
• Manage multiple priorities, document best practices, ensure HIPAA compliance, and identify process improvement opportunities.
• Mentor junior analysts and stay current with healthcare EDI standards, integration technologies, and AI advancements.

Skills

ANSI X12 5010

EDI troubleshooting

SQL

AI tools

Mentoring

Cross-functional

HIPAA compliance

Education

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

Tools

Edifecs

Crystal Validation

SQL Server

Jira

Job description

Zelis Healthcare, LLC is seeking an experienced EDI Integration Analyst to support the integration of systems, applications, and data sources for efficient operations. You will work with cross-functional teams to analyze requirements, design solutions, and implement integration processes.

You will analyze and troubleshoot ANSI X12 5010 835 transactions, perform root cause analysis, and design EDI workflows. The role emphasizes HIPAA compliance and collaboration with clients and trading partners.