EDI Analyst with HIE Experience - Hybrid

*** Webcam OR Inperson Interview(F2F )***Very long term project; initial PO for 1 year with multiyear extensions; ***Hybrid (3days per week onsite at Baltimore,MD)***Need 3 verifiable references ***

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 withtechnical and business teams to analyze error reports,
• access the HBX databases andapplications 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..

• 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.
• 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 preferred
• 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.