EDI 834 Functional Analyst

We are seeking a highly skilled and experienced EDI 834 Functional Analyst to join our team. The ideal candidate will possess expertise in Electronic Data Interchange (EDI) transactions, specifically with EDI 834, and will have a strong understanding of state and federal interfaces, particularly in the healthcare industry. This individual will work closely with internal stakeholders, vendors, and clients to ensure seamless integration of data between systems and regulatory compliance.

Key Responsibilities:

• Manage the design, development, testing, and implementation of EDI 834 transactions for member enrollment, eligibility, and benefits data exchange.
• Ensure proper data mapping, translation, and communication with trading partners using EDI standards and guidelines.
• Troubleshoot and resolve issues related to EDI 834 transactions, working closely with internal teams and external vendors.
• State and Federal Interface Management:
• Collaborate with state and federal agencies to manage and implement interfaces for healthcare-related programs such as Medicaid, Medicare, and the Affordable Care Act (ACA).
• Maintain knowledge of government regulations and standards for health data exchange, including but not limited to 834 file formats, HIPAA compliance, and other federal/state requirements.
• Support ongoing communication between internal systems and government systems to ensure data is accurately transmitted and received.

Data Mapping and Integration:

• Work with technical teams to map data fields between internal systems and external interfaces (e.g., state and federal health systems).
• Define and validate the structure and content of the 834 files to ensure accuracy and compliance.
• Participate in user acceptance testing (UAT) to verify data integrity and functionality for state and federal interfaces.

Documentation and Compliance:

• Document EDI 834 file specifications, workflows, and interface mappings.
• Ensure all processes and transactions meet regulatory standards and maintain HIPAA compliance.
• Stay up-to-date on changes to state and federal healthcare regulations and assess the impact on EDI processes.
• Work closely with internal departments (e.g., IT, Compliance, Business Analysis) and external partners to ensure smooth data exchange and system integration.
• Serve as the primary point of contact for questions and concerns related to EDI 834 transactions and state/federal interfaces.
• Provide regular status updates and reports on project progress, system issues, and resolutions.

Preferred Qualifications:

• Experience with other EDI transaction sets such as 835, 837, and 270/271.
• Familiarity with ACA (Affordable Care Act) enrollment systems.
• Experience with system integration and testing methodologies.