Senior EDI Operations Analyst - Eligibility SME

Liviniti; Minneapolis (MN); Remote; USD 80,000 - 120,000; Full time

Job summary

An established industry player is seeking a Senior EDI Operations Analyst to oversee and optimize electronic data exchange processes. This role involves managing HIPAA X12 EDI transactions, troubleshooting integration issues, and enhancing data quality. The ideal candidate will collaborate with teams to implement process improvements and automation while ensuring compliance with industry regulations. With a focus on innovation and problem-solving, this position offers the opportunity to make a significant impact in a dynamic environment. Join a forward-thinking company that values your expertise and provides a supportive workplace culture.

Benefits

Medical, Dental, Vision Insurance

Disability and Life Insurance

Employee Assistance Program

Remote Work Options

Paid-Time Off

Development Plans

Retirement Plan with company match

Qualifications

• 10+ years experience in eligibility management or data integration.
• Expert knowledge of eligibility file formats and systems integration.

Responsibilities

• Manage eligibility file transfers ensuring seamless data exchanges.
• Lead initiatives to enhance data integration and system performance.

Skills

Eligibility file formats

SQL

Data troubleshooting

File transmission protocols

Automation tools

Cloud-based EDI environments

Problem-solving skills

Project leadership

Communication skills

Stakeholder management

Education

Bachelor’s degree in related field

Master’s degree

Tools

EDI tools

Data mapping software

Job description

Senior EDI Operations Analyst - Eligibility SME

Join to apply for the Senior EDI Operations Analyst - Eligibility SME role at Liviniti.

This role involves overseeing and optimizing electronic data exchange (EDI) processes related to eligibility and enrollment. Key responsibilities include managing HIPAA X12 EDI transactions (834, 270/271, etc.), troubleshooting integration issues, improving data mapping accuracy, and ensuring compliance with industry regulations. The candidate will work cross-functionally to enhance data quality, system performance, and automation.

Key Responsibilities

1. Manage eligibility file transfers ensuring seamless data exchanges.
2. Lead initiatives to enhance data integration and system performance.
3. Design and implement eligibility file processes to streamline operations.
4. Identify automation opportunities and process improvements.
5. Troubleshoot advanced data exchange issues and resolve errors.
6. Evaluate and recommend tools for data processing and integrity.
7. Collaborate with teams and vendors to define data specifications.
8. Build relationships with stakeholders for issue resolution and process improvement.
9. Mentor junior staff and lead training sessions.
10. Ensure compliance with HIPAA and privacy standards.
11. Maintain documentation and report on system performance.

Troubleshooting & Issue Resolution

• Investigate and resolve EDI processing errors and failures.
• Analyze logs and error reports for root causes.
• Support teams and vendors with EDI workflows.

Compliance & Regulatory Standards

• Ensure transactions comply with HIPAA 5010, ACA, CMS guidelines.
• Maintain security and privacy policies.
• Stay updated on regulatory changes.

Process Improvement & Automation

• Identify workflow improvements and automation opportunities.
• Implement process automation and system upgrades.

What We Offer

• Medical, Dental, Vision Insurance
• Disability and Life Insurance
• Employee Assistance Program
• Remote Work Options
• Paid-Time Off and Development Plans
• Retirement Plan with company match

Required Skills and Competencies

• Expert knowledge of eligibility file formats and systems integration.
• Proficiency in SQL and data troubleshooting.
• Experience with file transmission protocols and automation tools.
• Knowledge of cloud-based EDI environments.
• Strong problem-solving and project leadership skills.
• Excellent communication and stakeholder management skills.
• Ability to adapt to changing needs and drive innovation.

Position Details

Full-time, remote, with flexibility for meetings across time zones. Occasional extended hours may be required.

Qualifications

• Bachelor’s degree in related field; Master’s preferred.
• 10+ years experience in eligibility management or data integration.
• Experience with healthcare data standards and file formats.
• Proficiency in SQL, data mapping, and troubleshooting complex issues.

Liviniti is an equal opportunity employer and complies with all applicable laws. We prohibit workplace harassment and discrimination.