Senior EDI Analyst: AI-Driven Healthcare Integrations

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

Job summary

Zelis is seeking an experienced EDI Integration Analyst to support the integration of systems, applications, and data sources, ensuring seamless and efficient operations across payers, providers, and clients.

You will work with cross-functional teams to analyze integration requirements, design solutions, and implement integration processes. The role emphasizes analytical, technical, and collaborative skills, with mentoring opportunities and AI-enabled efficiency improvements.

Qualifications

• Bachelor's degree or equivalent experience in Information Systems, Healthcare Administration, Computer Science, or related field.
• 5-7+ years healthcare EDI experience, including 3-5+ years supporting HIPAA ANSI X12 835; 837/834/270/271 a plus.
• Strong understanding of the healthcare claims lifecycle, payment processing, provider payment posting, and reconciliation.
• Experience with EDI validation tools (Edifecs, Crystal Validation), ANSI X12 standards, data mapping, and healthcare integration processes.
• Advanced SQL and data analysis skills; Microsoft SQL Server experience preferred.
• Proficiency with Microsoft Teams, Word, Excel, Notepad++, and AI tools such as ChatGPT; Jira, C#, or API experience a plus.
• Excellent analytical, communication, troubleshooting, and problem-solving skills, with the ability to mentor junior analysts and collaborate across teams.

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 compliance with 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

Analytical skills

Communication skills

Troubleshooting

Problem-solving

Education

Bachelor's degree or equivalent

Tools

Edifecs

Crystal Validation

SQL Server

Jira

C#

API

ChatGPT

Job description

Zelis is seeking an experienced EDI Integration Analyst to support the integration of systems, applications, and data sources, ensuring seamless and efficient operations across payers, providers, and clients.

You will work with cross-functional teams to analyze integration requirements, design solutions, and implement integration processes. The role emphasizes analytical, technical, and collaborative skills, with mentoring opportunities and AI-enabled efficiency improvements.