Senior EDI Systems Analyst

Job Title: Senior EDI Systems Analyst
Location: Hybrid - Baltimore, MD

Job 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.
Note: The candidate must be flexible to work overtime, on-site/off-site, as
needed, including weekends, holidays, and off-hours.
Minimum Qualifications
Education: Bachelor s degree from an accredited college or university in
Engineering, Computer Science, Information Systems, Business, or other related
disciplines.
A minimum of four (4) years of experience with the 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 in reviewing and understanding
technical documents such as 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/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 Qualifications
A minimum of six (6) years of experience with EDI validation tools such as
Edifecs, WTX, EDI X12 files, or equivalent.
A minimum of six (6) years of experience with EDI transaction sets such as 834,
820, 999, and TA1, SOA, EDI, or EAI applications.
A minimum of two (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.
In-depth understanding of EDI 834 enrollment transactions, including Adds,
Changes, Terminations, Cancellations, and error processing.
Documents to be Provided
Completed Attachment 1 note the required 3 references in section D