Sr. System analyst

Job Title

Duties/Responsibilities:

• Provide data analysis, transactional support, error detection, resolution, and all related services for the successful Electronic Data Interchange (EDI) Operations of the Exchange.
• Perform 8001 Medicaid transaction file analysis and validations.
• Review and resolve all data issues, including but not limited to Master Data Management (MDM), Master Person Identifier (MPI), and other data issues.
• Perform HBX System Error analysis.
• Validate 1095-A and 1095-B files, and reconcile 8001 transactions.
• Analyze EDI files sent to and received from Carriers, Managed Care Organizations (MCO), and other entities, and identify errors and root causes for EDI file rejections.
• Coordinate with the development team, business team, and testing team to analyze, fix, test, and transmit EDI files daily and as required.
• Analyze the EDI 999 files from the Carriers and MCOs and perform root cause analysis for exceptions, and assist with resolving any data issues.
• Perform data changes to fix consumer or system-reported errors, coordinate with technical and business teams to analyze error reports, access the HBX databases and applications to perform root cause analysis for transaction rejections, and provide data fixes and technical solutions.
• Communicate with the IT team, business team, vendor teams, and other stakeholders to translate business needs into EDI data fixes and solutions.

Required Qualification:

• 4 years of experience with the Health Exchange marketplace EDI solutions.
• 4 years of experience creating EDI X12 files for transaction sets such as 834, 999, and TA1.
• 4 years of experience in reviewing and understanding technical documents such as companion and implementation guides for Healthcare EDI formats 834 and 999.
• 4 years of experience in analyzing, testing, and providing data solutions for healthcare marketplaces.
• 2 years of experience working with SQL databases/queries.
• Strong analytical and problem-solving skills.
• Excellent communication skills, including the ability to understand and communicate technical information to business users and gather business requirements that can be translated into technical requirements.
• Ability to manage multiple critical priorities and tight deadlines.

Preferred Qualification:

• 6 years of experience with EDI validation tools such as Edifecs, WTX, EDI X12 files, or equivalent.
• 6 years of experience with EDI transaction sets such as 834, 820, 999, and TA1, SOA, EDI, or EAI applications.
• 2 years of hands-on experience writing complex SQL scripts.
• Knowledge of the Affordable Care Act (ACA) eligibility rules for Medicaid and Qualified Health Plans.
• Experience with or knowledge of Medicaid 8001 file processing or any other inter-agency transactional file processing.