Lead Edifecs resource || Remote || Contract

Job Summary

We are seeking an experienced Healthcare EDI / Edifecs Analyst to support HIPAA-compliant electronic data interchange operations within a healthcare environment. The ideal candidate will have strong expertise in Edifecs platforms, HIPAA X12 transactions, healthcare claims and enrollment processes, SQL, and production support.

This role will be responsible for monitoring and resolving EDI transaction issues, supporting trading partners, conducting data analysis, performing root cause investigations, and ensuring successful processing of healthcare transactions.

Key Responsibilities

• Manage and support end-to-end Healthcare EDI transaction processing for health plan and payer environments.
• Work extensively with Edifecs tools, including XEngine, SpecBuilder, Transaction Management, and Smart Trading.
• Monitor, validate, and troubleshoot HIPAA X12 transactions such as 837, 835, 834, 270/271, and 276/277.
• Investigate transaction failures, rejected files, data discrepancies, and production incidents.
• Perform detailed root cause analysis (RCA) and coordinate with technical, business, and trading partner teams to resolve issues.
• Utilize SQL queries to validate healthcare data, investigate transaction errors, and reconcile source and target data.
• Support trading partner onboarding, transaction certification, compliance validation, and connectivity setup.
• Work with EDI communication protocols such as SFTP and AS2.
• Analyze healthcare workflows related to claims, enrollment, eligibility, encounters, and payment processing.
• Collaborate with internal teams and external partners to resolve EDI-related production issues within established SLAs.
• Maintain incident records and provide updates through tools such as Jira and ServiceNow.
• Participate in production releases, testing, validation, and post-deployment support activities.
• Prepare technical documentation, issue analysis, process documentation, and operational reports.
• Coordinate with onsite/offshore teams when required to ensure smooth delivery and support.

Required Qualifications

• 5+ years of experience in Healthcare EDI / HIPAA transaction processing within a payer, health plan, or healthcare organization.
• 3+ years of hands-on experience with Edifecs and its EDI processing capabilities.
• 3+ years of experience working with HIPAA X12 transactions, including:
  • 837 – Healthcare Claims
  • 835 – Healthcare Payment/Remittance
  • 834 – Benefit Enrollment
  • 270/271 – Eligibility Inquiry/Response
  • 276/277 – Claim Status Inquiry/Response
• 2+ years of experience in EDI production support, incident investigation, troubleshooting, and root cause analysis.
• 2+ years of hands-on SQL experience for data validation, reconciliation, healthcare data analysis, and troubleshooting.
• Experience with trading partner implementation/onboarding and EDI compliance testing.
• Practical knowledge of SFTP and AS2 connectivity.
• Strong understanding of healthcare business processes involving claims, enrollment, eligibility, payments, and encounter data.
• Experience using Jira, ServiceNow, or similar incident/ticket management platforms.
• Strong analytical, troubleshooting, communication, and problem-solving skills.

Education

• Bachelor's degree in Computer Science, Information Systems, Healthcare Informatics, or a related field.
• Equivalent professional experience may be considered in lieu of a degree.

Preferred Qualifications

• Experience supporting Medicare, Medicaid, or Commercial Health Plan implementations.
• Previous experience serving as an EDI technical lead or coordinating onsite/offshore teams.
• Knowledge of XML, XSD, EDI mapping, and data transformation concepts.
• Experience working in Agile/Scrum development and production support environments.
• Experience coordinating with business analysts, developers, QA teams, infrastructure teams, and external trading partners.
• Strong understanding of healthcare payer technology and EDI compliance standards.

Travel

Occasional travel may be required depending on project requirements, client needs, and business priorities.