EDI Analyst/Developer

Position Overview

Job ID: MD-RFR#150
Hybrid/Local HIX EDI Analyst/Developer (Health Exchange must) with X12/834/999/TAI, testing/data analysis, SQL Server, Edifecs/WTX, SOA/EAI, ACA, Medicaid 8001/1095, QHP, MDM, MPI experience.
Location: Baltimore, MD (MHBE)

Duration:

Key Responsibilities

• Provide data analysis, transactional support, error detection, and resolution for the successful operation of the Exchange’s EDI processes.
• Perform 8001 Medicaid transaction file analysis and validations.
• Review and resolve all data issues, including Master Data Management (MDM) and Master Person Identifier (MPI) concerns.
• Conduct HBX System error analysis.
• Validate 1095-A and 1095-B files and reconcile 8001 transactions.
• Analyze EDI files received from and sent to Carriers, Managed Care Organizations (MCOs), and other entities to identify errors and determine root causes for file rejections.
• Coordinate with development, business, and testing teams to analyze, fix, test, and transmit EDI files daily as required.
• Examine EDI 999 files from Carriers and MCOs, performing root cause analysis for exceptions and assisting with resolving data issues.
• Implement data changes to correct consumer or system-report errors, and provide technical solutions in coordination with IT and business teams.
• Communicate with IT, business, and vendor teams to translate business requirements into effective EDI data fixes and solutions.
• Demonstrate flexibility to work overtime, including weekends, holidays, and off-hours as necessary.

Required Qualifications

• A minimum of four (4) years of experience with Health Exchange marketplace EDI solutions.
• A minimum of four (4) years of experience creating EDI X12 files for transaction sets such as 834, 999, and TA1.
• A minimum of four (4) years of experience reviewing and understanding technical documents including companion and implementation guides for Healthcare EDI formats 834 and 999.
• A minimum of four (4) years of experience in analyzing, testing, and providing data solutions for healthcare marketplaces.
• A minimum of two (2) years of experience working with SQL databases and writing queries.
• Strong analytical and problem-solving skills.
• Excellent communication skills with the ability to translate technical requirements for business users.
• Ability to manage multiple critical priorities and work under tight deadlines.

Preferred Qualifications

• A minimum of six (6) years of experience with EDI validation tools such as Edifecs, WTX, or equivalent.
• A minimum of six (6) years of experience with EDI transaction sets including 834, 820, 999, and TA1, as well as familiarity with SOA, EDI, or EAI applications.
• A minimum of two (2) years of hands-on experience writing complex SQL scripts.
• Knowledge of Affordable Care Act (ACA) eligibility rules for Medicaid and Qualified Health Plans.
• Experience with or knowledge of Medicaid 8001 file processing or similar inter-agency transactional file processing.
• In-depth understanding of EDI 834 enrollment transactions, including processing of Adds, Changes, Terminations, Cancellations, and managing error resolutions.