EDI Technical Analyst

Job not on LinkedIn

🔥 13 hours ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

📞 Support Engineer

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Tegria

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2020

💼 Consulting

🏥 Healthcare

⚕️ Healthcare Insurance

Consulting • Healthcare • Healthcare Insurance

Tegria is a global healthcare consulting and services company that partners with provider and payer organizations to advance care, improve performance, and tackle the biggest challenges in healthcare. They offer a range of services including patient access optimization, data analytics, cloud solutions, and revenue cycle transformation to create value and enhance healthcare delivery. Tegria focuses on streamlining operations, fostering innovation, and leveraging technology to maximize performance and improve patient experiences.

📋 Description

• Analyze, configure, implement, and support healthcare EDI transactions • Monitor daily EDI processing and resolve transaction failures, rejections, and data integrity issues • Conduct root cause analysis and recommend corrective actions for production issues • Collaborate with business and operational teams to identify EDI requirements and system enhancements • Analyze inbound and outbound EDI files and transaction sets for HIPAA compliance • Create and maintain mapping specifications, technical documentation, and data flow diagrams • Perform impact assessments for system upgrades, regulatory changes, and business initiatives • Support integration between payer core administration systems and external trading partners • Coordinate and execute unit, system, integration, and user acceptance testing • Develop test plans, test cases, and validation procedures • Facilitate onboarding of providers, clearinghouses, employer groups, and vendor trading partners • Validate EDI transaction accuracy during implementations and system upgrades • Ensure compliance with HIPAA X12 standards and CMS regulations • Stay informed about industry changes affecting EDI transactions and healthcare interoperability • Support audit requests and regulatory reporting activities • Partner with business analysts, developers, operations teams, providers, clearinghouses, and external vendors • Serve as a subject matter expert for EDI processes and transaction troubleshooting • Provide production support and participate in issue resolution meetings

🎯 Requirements

• Bachelor's degree in Information Systems, Healthcare Administration, Computer Science, or equivalent work experience • 3+ years of healthcare EDI experience within a payer organization • Strong knowledge of HIPAA X12 transaction sets (834, 837, 835, 270/271, 276/277, 278, 820) • Experience working with healthcare claims, enrollment, eligibility, provider, and payment processes • Proficiency in analyzing EDI files and troubleshooting transaction errors • Experience with SQL and database querying • Understanding of healthcare payer operations and managed care concepts • Strong analytical, problem-solving, and communication skills • Experience with payer platforms such as Facets, QNXT, or HealthRules Payor • Experience with EDI tools such as IBM Sterling, Edifecs, BizTalk, or Cleo • Knowledge of XML, JSON, APIs, and healthcare interoperability standards • Experience supporting Medicare, Medicaid, and Commercial lines of business • Familiarity with Agile methodologies and project management practices

🏖️ Benefits

• Multiple health and dental plans with nationally recognized networks • Vision benefits • Total wellness program • Employee assistance program for employees and families • Competitive wages • Retirement savings plans • Company-paid disability and life insurance • Pre-tax savings opportunities (HSA and/or FSA) • Professional development offerings • Opportunities for remote work • Generous paid-time-off program • Flexible scheduling to accommodate vacations, illness, life events, and unexpected circumstances