Facets EDI Specialist

Job Title: Facets EDI Specialist

Location: 100% Remote

Duration: Long Term Contract

Job Summary

We are seeking an experienced Edifecs Encounter Specialist with strong hands-on experience in healthcare encounters, Edifecs, and encounter data processing.

The ideal candidate will have a solid understanding of encounter lifecycle, encounter validation, error analysis, data quality, and healthcare claims/encounter processes.

The candidate should also have working knowledge of Facets navigation and be comfortable analyzing encounter-related data and resolving issues.

Experience with BI dashboards and reporting tools is a plus.

Key Responsibilities

• Work with Edifecs Encounter Management and support healthcare encounter processing activities.
• Analyze, validate, and troubleshoot encounter data to ensure accuracy and completeness.
• Perform encounter data validation and reconciliation across various healthcare data sources.
• Work with healthcare claims and encounter transactions and understand their processing lifecycle.
• Use Edifecs tools/platforms for encounter analysis, validation, and issue resolution.
• Perform data investigation and identify discrepancies in encounter records.
• Understand healthcare payer processes and data requirements related to Medicaid/Medicare encounters.
• Navigate Facets to investigate member, claim, provider, and related healthcare information.

Required Skills

• Strong hands-on experience with Edifecs.
• Strong experience working with Healthcare Encounters.
• Experience analyzing encounter errors, rejects, and exceptions.
• Facets navigation experience is highly preferred.
• Understanding of healthcare data and member/provider/claim information.
• Experience with data validation and reconciliation.

Preferred / Nice-to-Have Skills

• Experience with BI dashboards / Business Intelligence reporting.
• Experience with Power BI, Tableau, or similar BI tools.
• SQL experience for encounter data analysis and validation.
• Experience with Medicaid/Medicare encounter processing.
• Knowledge of EDI transactions and healthcare data standards.