ASSYST · 4 hours ago
Healthcare EDI Analyst
Baltimore, MD
Full-time
Hybrid
Mid LevelASSYST is seeking an experienced Healthcare EDI Analyst for supporting the Electronic Data Interchange (EDI) operations of our client. This role involves detailed data analysis, transaction validation, and collaboration with technical and business teams to ensure accurate and compliant data exchanges with external partners.
Big DataEnterprise Resource Planning (ERP)
Responsibilities
Provide data analysis, transactional support, error detection, resolution and related services to ensure successful Electronic Data Interchange (EDI) operations for the client
Perform analysis and validation of Medicaid 8001 transaction files and reconcile associated enrollment and eligibility data
Review, analyze and resolve data issues related to Master Data Management (MDM), Master Person Identifier (MPI) and other data integrity concerns
Conduct HBX system error analysis to identify and resolve transaction failures
Validate 1095-A and 1095-B files and reconcile 8001 transactions to ensure data accuracy and regulatory compliance
Analyze inbound and outbound EDI files exchanged with Carriers, Managed Care Organizations (MCOs) and other external entities; identify errors and determine root causes for EDI file rejections
Coordinate with development, business and testing teams to analyze, resolve, test and transmit EDI files on a daily basis and as required
Analyze EDI 999 acknowledgement files from Carriers and MCOs, perform root cause analysis for exceptions and assist in resolving data-related issues
Perform data updates to correct consumer- or system-reported errors and work with technical and business teams to analyze error reports
Access HBX databases and applications to perform root cause analysis for transaction rejections and implement data fixes and technical solutions
Communicate with IT teams, business stakeholders, vendor teams and external partners to translate business requirements into effective EDI data fixes and solutions
Qualification
Required
Experience supporting Health Exchange marketplace EDI solutions
Experience creating EDI X12 files, including transaction sets 834, 999 and TA1
Experience reviewing and interpreting technical documentation such as EDI companion guides and implementation guides for healthcare EDI formats (834 and 999)
Experience analyzing, testing and delivering data solutions for healthcare marketplaces
Experience working with SQL databases and queries
Strong analytical and problem-solving skills
Excellent communication skills, with the ability to explain technical concepts to business users and translate business requirements into technical solutions
Ability to manage multiple critical priorities and work effectively under tight deadlines
Preferred
Experience using EDI validation tools such as Edifecs, WTX, or equivalent
Experience working with EDI transaction sets including 834, 820, 999 and TA1, as well as SOA, EDI, or EAI applications
Hands-on experience writing complex SQL scripts
Knowledge of Affordable Care Act (ACA) eligibility rules for Medicaid and Qualified Health Plans
Experience with Medicaid 8001 file processing or other inter-agency transactional file processing
In-depth understanding of EDI 834 enrollment transactions, including adds, changes, terminations, cancellations and error processing
Company
ASSYST
ASSYST is a global CMMI level 3 information technology solutions provider.
Founded in 1993
51-200 employees
H1B Sponsorship
ASSYST has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2024 (2)
Funding
Current Stage
Growth StageLeadership Team
Shyama Mandal
Chief Executive Officer
Recent News
2025-07-16
Company data provided by crunchbase