Senior X12 Healthcare Transaction SME /Business Systems Analyst/Remote
Location: Remote within the continental U.S.
Duration: Approximately 24 months
Schedule: Monday–Friday, Pacific Time business hours
Industry: Healthcare / Medicaid / Managed Care
Description:
We are seeking an experienced X12 Healthcare Transaction Subject Matter Expert (SME) to support a large public-sector healthcare initiative involving provider information, managed-care network adequacy, healthcare data analysis, and X12 transactions.
Important: Candidates must clearly demonstrate at least 3 years of hands-on X12 transaction experience. Resumes that only mention EDI without identifying actual X12 experience may not be considered.
Mandatory Qualifications
Candidates must meet all of the following:
- Minimum 5 years of full-time experience applying analytical processes on IT projects.
- Bachelor's degree. Additional qualifying experience may substitute for education on a year-for-year basis.
- Minimum 3 years of full-time experience in business systems analysis and design.
- Minimum 3 years of experience working with program staff, management, and stakeholder relationship management.
- Minimum 3 years of hands-on experience working with X12 transactions.
Preferred Qualifications
Strong preference for candidates with:
- More than 3 years of healthcare X12 transaction experience.
- Experience with X12 274 – Health Care Provider Directory.
- Experience with transactions such as 270/271, 834, 835, 837, or related healthcare X12 transactions.
- Healthcare data modeling experience.
- Managed-care health plan experience involving Provider Information Data.
- Medicaid/Medi-Cal or other government healthcare program experience.
- Experience with healthcare claims and encounter-processing systems.
- Experience preparing or contributing to budget-related documents or workbooks, including Advanced Planning Documents (APDs).
Responsibilities
- Analyze healthcare provider-information and X12 transaction requirements.
- Perform business systems analysis, requirements analysis, and gap analysis.
- Review provider-data collection, reporting, and data-quality processes.
- Identify data inconsistencies, anomalies, and process gaps and recommend corrective actions.
- Support healthcare provider-directory and network-data initiatives.
- Develop business and system requirements.
- Work with business, technical, program, management, and external stakeholders.
- Facilitate requirements-gathering and analysis sessions.
- Develop documentation, analyses, recommendations, and status reports.
- Provide X12 transaction subject-matter expertise and knowledge transfer.
- Track project issues, risks, dependencies, and action items.
Required Candidate Submission
Please provide:
- Current resume with month/year dates for all relevant positions and projects.
- Specific X12 transaction numbers worked with.
- Total years/months of X12 experience.
- Education details.
- Current location and availability.
- Expected hourly rate.
- Two professional references who can verify relevant work experience.
Important: Candidates must clearly demonstrate at least 3 years of hands-on X12 transaction experience. Resumes that only mention EDI without identifying actual X12 experience may not be considered.
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