EDI Analyst

EDI Analyst

Zelis is pursuing an aggressive organic and non-organic growth strategy focused on providing superior healthcare claim lifecycle solutions to payors, providers and individuals from pre-payment through payment. As the company executes its growth strategy, Zelis is currently hiring an EDI Analyst. The position will report to an EDI Manager and will work closely with managers and various team members. 

Use advanced test editors and other technology tools to review X12 835 files for issues, to include but not limited to the following: 

• Balance, structure, syntactical, data type and content errors; to develop and execute strategies to solve them.

• Troubleshoot by querying the database using SQL Management Studio to review stored values and/or using a text editor to manually review data files sent to Zelis by our Payer clients.

• Support Payer and Provider client implementation activities by generating 835 files, reviewing content and then presenting findings to Zelis clients. 

• Respond to inquiries regarding 835 issues, claims, payments, and/or clearinghouse activities. 

• Interacting with other departments on communication issues related to customer and third-party vendor connectivity.

• User acceptance testing to approve items for release.

• Communicate with vendor contacts to identify file issues and disseminate the resolution to the provider or payer to maintain compliance with all HIPAA and Zelis data security standards.

• Support multiple client projects simultaneously.

• Ensure proper follow up and completion of projects. 

• Work under pressure with multiple deadlines.

• Work on assignments that are complex in nature in which judgment, critical thinking and initiative are required to accomplish the objectives of the assignment. 

REQUIRED EXPERIENCE:

• 3+ years EDI experience to include 1 year of healthcare

• Technical solution guidance & design – user acceptance testing

• Create, lead and facilitate presentations to Operations team, and internal & external stakeholders & clients

PREFERRED EXPERIENCE:

• Bachelor’s degree

• EDI files (fixed length, delimited, X12 and/or EDI 835) and adjudication systems

• SQL knowledge

• Advanced test editors or other technology tools

• Provider billing and/or claims payment experience helpful

• Excellent communication skills

Location and Workplace Flexibility: 

We have offices in Atlanta GA, Boston MA, Morristown NJ, Plano TX, St. Louis MO, St. Petersburg FL, and Hyderabad, India. We foster a hybrid and remote friendly culture and all of our employee's work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies.